Functional Neurological Disorder–Old Problem New Perspective 2023 Perjoc et al

Abstract

Functional neurological disorder (FND) is a common issue in the pediatric population. The concept and our understanding of functional neurological disorders have changed over the past years, and new etiologic models and treatment plans have been explored. Knowledge about FND in the pediatric population, however, is lacking. The aim of this review is to provide an update on pediatric functional neurological disorder.

We conducted a literature search of PubMed and SCOPUS databases and reviewed a total of 85 articles to gain insight into the current understanding of FND etiology, diagnosis, treatment, and prognosis in children and adolescents. Functional and high resolution MRI revealed abnormal connectivity and structural changes in patients with functional symptoms. The diagnostic criteria no longer require the presence of a psychological factor and instead focus on a rule-in diagnosis. Treatment of FND includes a clear communication of the diagnosis and the support of a multidisciplinary team. Although FND typically has a poor prognosis, better outcomes appear to have been achieved in children and young adults.

We conclude that pediatric functional neurological disorder is a prevalent pathology and that this patient population has additional specific needs compared to the adult population.

Open access, https://www.mdpi.com/1660-4601/20/2/1099

 

Good that they're (allegedly) moving away from psychological factors as the aetiology. But how does this make any sense?

Agree with this bit though —

 

It would take some research for me to identify the exact nature and lineage of this particular flavour of bull****ery.

I am reminded of the present and unfolding appropriation within the NHS by BPS proponents of arthritis, MS and cancer patients.

Along with asthma patients, poor things only just relieved of their “mother smothered child” status (a label that was quietly dropped by its enthusiastic well qualified proponents) a short lived holiday with biology apparently.

BPS literature suggests that the real pain and suffering from all these conditions comes from the “distress” that patients feel about their pain or impending deaths. I would say, that psychological support is secondary. If you’re suffocating screaming in agony, so weakened that you can’t engage or no longer alive, as a patient you would not be able to engage with psychological support. If that is, psychological support were to be offered. But it’s not actually being offered is it?

Are those same professionals who told you you were “the worried well” when you had MS related fatigue or stage four cancer really who you want taking charge of your emotional welfare?
I would say not.

Since M.E and C.F.S were first targeted and categorised as non-diseases by the up and coming and the eminent the pattern has remained the same. BPS crew has declared it that certain conditions are to be exorcised like a demonic cluster- not a dangerous tenacious or biological possession, simply thoughts to be unthought or exercised out or thrown into a swimming pool, where they would leave the body of this boy child…. because water is holy?

The BPSer has always
spoken out of both sides of their mouths. They have always been ready to re characterise each of their creations to better protect themselves from ever being found out as wrong. This is the fabric from which their safety harnesses are made. Venture up into the metaphorical airplane or helicopter with ‘carefully selected’ patient groups. Then pushed out the patients for an invigorating free fall. But they themselves always had a parachute packed checked and ready to go.

I think of their response to this discovery of biological abnormality in a cohort of patients that they have already identified and labelled specifically as having none as in keeping with their full history. They do not reevaluate. No new diagnosis that could include these abnormalities is offered. No removal of the original diagnosis is actioned. Instead tweaking the meaning of their diagnosis ever so slightly. No adjustment to non medical treatment protocol. All this simply amounts to routine parachute checks. Built in to the original system no new development here.



Edited to break text block.

 

Worms wriggled out of the can.

 

Consider this totally hypothetical case —

This imaginary young person might well qualify for a diagnosis of ME/CFS if seen by someone knowledgeable. Instead, they were referred to a neurologist and "Functional Neurological Disorder" is now at the top of the problem list. If you were in a position to view the clinic letters, you might read the specialist's narrative of the encounter, including their explanation of FND to the patient and family — and how they agree with the previous neurologist and are certain it is the correct diagnosis. Psychological factors and anxiety are definitely the cause.

This is despite at the same time detailing that everything so explained, everything previously predicted to follow clinical advice, has been completely contrary to the patient experience.

Perhaps you might read on and find the concluding hand-waving to be spectacularly logic-defying in its circularity. In fact it might be definitively asserted that this very lack of concordance reinforces confidence in the diagnosis of FND even further, because (in the experience of the expert) the majority of patients diagnosed with FND are similarly non-concordant with said explanations and predictions.

Q.E.D.

 

Yeah I get it @shaun.
You’re jealous because you don’t have the authority to dictate what words mean. I guess it’s just the social hierarchy in action. What can you do?

For you and I at any one point in time words will mean what they are explained to mean through history and by consensus.

Whereas these fellas can say a word has a certain meaning on one day and another the next. Changing meaning again and again as their whims or self interest dictate, without ever issuing any notices to readers of their works, explaining that their self defined words no longer mean what they said they meant and now they mean something else either a little bit but importantly different or essentially and altogether different. Opposite even.

 

Is the latest trend in fnd letting the cat out of the bag and telling the truth about fnd.
Reminds me of the post
Challenges to the Diagnosis of Functional Neurological Disorder: Feigning, Intentionality, and Responsibility 2022 Mason

 

The literature seems to posit that the structural changes might be as a result of the functional disorder, not the cause of it

 

So still arse over elbow .
The king is dead .....

 

Yeah its like the chicken or the egg.
Which came first can be argued in many different ways.

The fnd guys say that fnd causes structural changes how can the argue that when the whole ideal of conversion is unobservable and almost untestable.