Functional Neurologic Disorder, La Lésion Dynamique, 2024 Wartenberg Lecture, Mark Hallett

Abstract

Functional neurologic disorder is common and a significant cause of disability and stress in neurologic patients. The nature of this disorder has been unclear. Originally called hysteria, the disorder interested Charcot who postulated that a functional lesion, la lésion dynamique, was responsible. Recent studies of functional neurologic disorders now allow us to understand what la lésion dynamique is and identifies these disorders without ambiguity as arising from the brain. Functional neurologic disorders are best understood as a multifactorial process with a biopsychosocial model. There can be a genetic predisposition. Commonly there is early life trauma that leads to a developmental abnormality of the amygdala, including loss of inhibition. This abnormality can be considered a predisposing factor. When stressed, the amygdala becomes hyperactive, driving the limbic system to cause widespread network dysfunction in the brain. This dysfunction can improve, correlating with clinical improvement. Network dysfunction is becoming recognized as an important pathologic process in neurology and psychiatry, as real as any other pathology. We should be able to make progress in helping patients with functional neurologic disorders with this understanding of la lésion dynamique.

Paywall, https://www.neurology.org/doi/10.1212/WNL.0000000000210051

 

How can a lesion ever be functional? Someone either has a lesion or they don't.

 

This feels like it’s showing how neurology has moved backwards in competence since the times of Charcot.

none of these asserted things are based on unbiased observations taken methodically and sadly even if it was supposedly collected representative ly to claim things like ‘trauma’ I frankly don’t believe they aren’t being encouraged to not hear and ignore and ‘reframe’ other things that might be consistently noted by patients when giving a history whilst they ‘go fishing’ or assume on the ‘childhood trauma’ etc front. Because those ‘interested in’ writing these articles tend to be locked into preconceived beliefs based on theories and assumptions

 

Sidenote: Mark Hallett is an author in Walitt's "deep phenotyping"/effort preference paper and he commented on the draft of the connected "exploratory study" on PEM in ME/CFS which consisted of a questionnaire study led by a NCCIH lady who spent her career surveying the use of complementary health approaches in the USA.

(Next to the bonkers state of having this woman lead a questionnaire study into post exertional malaise in what was sold as a serious biomedical effort to get to the bottom of PEM, I noticed that the study focuses on PEM "perception" and nudges the reader towards the impression that a patient's account on the severity of their symptoms is not to be trusted. The VAS focuses on "how you are feeling". All fitting the NCCIH's interoception project, and Walitts' effort preference study itself, which had NCCIH staff popping up all over the place.)

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