Functional neurological disorder: Clinical manifestations and comorbidities; an online survey 2023 Ducroizet, Edwards et al

Abstract

Functional Neurological Disorder (FND) is common and is often accompanied by multiple comorbid symptoms and conditions. There have been no large-scale studies exploring the change of its clinical manifestations and comorbidities.

We used an online survey to assess FND patient characteristics, changes to fatigue, sleep and pain and comorbid symptoms and diagnoses, as well as treatment strategies. The survey was shared via the charities FND Action and FND Hope.

527 participants were included in the analysis. Most (97.3%) reported experiencing more than one core FND symptom. Many respondents reported associated pain (78.1%), fatigue (78.0%) and sleep disturbances (46.7%) before FND diagnosis which often increased thereafter. Rates of obesity were higher (36.9%) than in the general population. Obesity was associated with increased pain, fatigue and sleep difficulties. There was frequent weight gain after diagnosis. 50.0% of participants reported having other diagnoses prior to FND, while in 43.3% new comorbidities arise after FND diagnosis. Many respondents reported being dissatisfied with their care, expressing a wish for further follow-up from mental health (32.7%) and/or neurological services (44.3%).

This large online survey further supports the phenotypic complexity of FND. High rates of pain, fatigue and sleep disturbance exist before diagnosis but monitoring for change is worthwhile. Our study identified major gaps in service provision; we highlight the importance of an open mind regarding change in symptoms; this could aid the early identification and management of co-morbidities, including obesity and migraine, which possibly have a negative impact on FND.

Paywall but with 'section snippets', https://www.sciencedirect.com/science/article/abs/pii/S0967586823000450

 

"Alongside the core neurological symptoms of FND, associated physical symptoms such as pain and fatigue are of particular importance [[11], [12]] since such symptoms can impair quality of life and adversely affect prognosis [[11], [12], [13]]. There is also significant overlap in the symptoms described in functional disorders of different bodily systems such as fibromyalgia and chronic fatigue syndrome; particularly in the way cognitive difficulties are described, suggesting potentially shared underlying mechanisms [[14], [15]]. Although previous studies have reported high rates of comorbid chronic pain and fatigue in FND, it is unclear to what extent such symptoms and diagnoses precede the development of FND symptoms [[11], [13], [16], [17]] and how they develop after diagnosis. It is also unclear to what extent people with FND subsequently develop other changes to their health, such as weight changes and new co-morbidities. Interestingly, sometimes FND is wrongly diagnosed as other neurological conditions, which can then be ‘undiagnosed’ [18]."

 

Also, which is it: rare or common? Are they trying to capture everything?

 

How do they speak with such certitude in deeming ME a functional disorder? Does anyone ever question this during a review process? Does anyone ever contact the authors to ask them what empirical evidence allows them to make such a designation?

 

If they say it often enough then they hope it will become the accepted 'truth', and I would imagine that the majority of reviewers either know no different, or agree with them.

 

Sure sounds like it to me.

 

Yeah, the newest landgrabbing attempt of FND zealots is to rebrand ME/CFS as a Functional Cognitive Disorder.

There seems to be some sort of anchoring bias in play where, to these Neurologists, all organic causes of cognitive dysfunction ought to result in a phenotype comparable to Alzheimer's, while all others go straight to the "FCD" wastebasket, with the suggested shared mechanism purportedly being "somatic bias" leading to "increased perception of effort", ultimately crippling the patient through fear of cognitive exertion. Their falsely dichotomous model does not permit space for differing types of cognitive dysfunction arising from non-degenerative brain disease, systemic metabolic or neuroimmune dysfunction; it's either neurodegeneration or FND.

I'd guess that cognitive dysfunction in ME would be better explained via brain hypoperfusion than impaired metacognition, but hey, what do we know.

 

The whole "functional overlay" nonsense says it all. If they had their way, illness would be banished from medicine, only disease matters. Everything else, all your symptoms and suffering? Emotional distress, and nothing else. Symptoms have to be blessed as real by a medical priest, on the basis of confirmed disease, otherwise they are just perception and you have control over all of this. Somehow. No evidence needed.

And even then, there is no disease where all the symptoms couldn't be dismissed this way. This ideology has no limits, no line it won't cross, they already showed willingness to go as far as it goes when it was applied to cancer.

I think that's the ultimate goal. Medicine has made no progress understanding illness. They only know disease, at least on a scientific level. This makes the failure vanish, framing it not as a failure, but as a simple misunderstanding, that actually symptoms are just the "worrying signal" part of disease, and that signal can just go wrong sometimes. Or whatever. Again, zero evidence needed for any of this.

 

They talk about Chronic Fatigue Syndrome not ME/CFS so they are obviously using the term the way Sharpe and co did and ignoring every symptom except fatigue if they even know about them.

That said, they find it easy to shoehorn every disease they come across into FND so I doubt if knowing the true presentation of ME would make any difference.

They admit that FND is the modern name for hysteria and that is what Wessely claimed about ME and the Royal Free because of the preponderance of women patients.

 

I thought (on the basis of zero evidence, I must admit) that "functional overlay" was a relatively new idea, perhaps developed since the 1990s.

But I just came across this article entitled "The Functional Overlay" from the Lancet published in December 1967.

https://www.sciencedirect.com/science/article/abs/pii/S0140673667919095

It is shocking, in my opinion.

 

Functional overlay can also be attributed to Freud too.

 

It's a common trope to frame FND as a recent thing, too. I've seen references to it from the 19th century, of course as it's just an alternative label for conversion disorder. Pretending this is all novel and "promising" (for decades, somehow) is clearly part of the con, but the fact that regulators, funders and gatekeepers play along is just grotesque. It's the lies, so many lies.

It's a cycle, or maybe a recycle would be more apt. We saw a recent marketing paper trying to push ACT, and their recommendations basically amount to doing the entire cycle they did with CBT all over again like it's some revolutionary thing. Test it for this, and for that, and for this condition, and for that personality trait or this other BS distinction without a difference. A jobs program, basically.

They have nothing, so pretending that everything they have is new, but also well-validated, is necessary to keep funding this. It's maddening how blatant the fraud is.