Functional Neurological Disorder (FND) - articles, social media and discussion

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Here is an important point: if you come on MY posts to argue with me, be prepared to defend your position. If you can't defend your position, don't comment. This will be my last post reinstating the obvious for those who still have doubts or are unclear, unsure or confused:
✔️ POTS is not a psychiatric disorder
✔️ POTS is not functional or "functional neurologic disorder."
✔️ Stress is a major trigger and must be reduced; psychiatric comorbidities must be treated IF/WHEN present
POTS is a neurologic and cardiovascular disorder with multiple symptoms and comorbidities: FND is not a common comorbidity.

Wishing everyone a great day and an exciting #DysConf2024!
 
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Judge rules forklift truck driver's rare Long Covid symptom is a disability

Mr Thompson was dismissed from his job in May 2023 and in July he was diagnosed as having a functional neurological disorder resulting from Long Covid. He then launched an employment tribunal claim for disability discrimination.

Employment Judge Humble has now ruled that Mr Thompson's condition is a disability and therefore he can proceed with his claim for discrimination. A final hearing is due to be held from October 22 to October 24.

"Further, it was a long-term condition. Even if the substantial adverse effect had not lasted as long as twelve months by early 2023, it was likely to do so given that it was a deteriorating condition which was still awaiting further assessment. The tribunal therefore find that the claimant was disabled on 17th May 2023, which is the material time for the purposes of the claim."

LINK
 
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Interesting, thanks Mij.

The judge said: "The tribunal held, on the balance of probabilities, that the claimant had the impairment of a functional neurological disorder resulting from Long Covid which caused an impairment to his left leg and that it had a substantial adverse effect (being more than minor or trivial) on his day to day activities by May 2023.
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Notable that having Long Covid was said by the judge to have given rise to a functional neurological disorder. That's slightly weird - I would have thought the hypothesis would be for FND to be the result of Covid-19. Long Covid (the persistent symptoms) essentially constitutes the FND. But, in any case, it's more evidence that people with Long Covid are being diagnosed with FND.

Also notable that being labelled with a 'functional neurological disorder' does not seem to have stopped this man from being classified as 'disabled by a long-term condition' at that particular time. I wonder how much bearing the finding that the condition 'was still awaiting further assessment' had. If he had been quickly assessed when the condition arose and had been told that he could think his way out of his symptoms by a consultant, and then was still claiming to be disabled, I wonder what the outcome would have been.

Perhaps the arguments that FND is treatable and any ongoing disability is due to a lack of compliance with the treatment might have been wheeled out. But, those arguments are very weak and don't seem to be getting stronger.
 
Hutan said:
Notable that having Long Covid was said by the judge to have given rise to a functional neurological disorder. That's slightly weird - I would have thought the hypothesis would be for FND to be the result of Covid-19. Long Covid (the persistent symptoms) essentially constitutes the FND.
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The neurologist who tried to pin FND on me made a similar distinction - he was happy to agree that I'd initially had Long Covid, i.e. some lingering symptoms after acute infection, but that this had now "transitioned" into FND because I was traumatised by the illness so I was imagining myself still to be ill. I did explain to him that I hadn't experienced any trauma, but sadly he seemed to develop Functional Deafness Disorder every time I spoke.
 
Eleanor said:
The neurologist who tried to pin FND on me made a similar distinction - he was happy to agree that I'd initially had Long Covid, i.e. some lingering symptoms after acute infection, but that this had now "transitioned" into FND because I was traumatised by the illness so I was imagining myself still to be ill. I did explain to him that I hadn't experienced any trauma, but sadly he seemed to develop Functional Deafness Disorder every time I spoke.
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I hope something like this doesn't happen to me because there's almost zero chance I wouldn't just call them stupid for believing in bullshit like this. Which I assume would leave some note on my record about being unpleasant and non-compliant. Although also maybe jovial, since I'd probably laugh and point at them a lot, probably make a few too many air jerking motions. I'd try to make sure that that I laughed at them makes it into the notes. For accuracy's sake.

At least try to make some damn sense. When someone talks about stuff like this I pretty much only hear squeaky fart noises.
 
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BBC Radio 4 programme featuring 'Functional Neurological Disorder' (FND)

I haven't listened to this yet, but can be fairly confident that it will be a load of cr*p, knowing Claudia Hammond's views/approach:

"All in the Mind

FND - the most common disorder you’ve probably never heard of; political polarisation; All in the Mind Awards judge ZeZe

Functional Neurological Disorder, or FND, is the most common disorder you’ve probably never heard of. Some say it might be as common as MS or Parkinson’s and yet it’s not well known even by many medical professionals. It can cause seizures, paralysis, convulsions and changes in sensation, as well as pain, fatigue and memory difficulties.

It’s caused by a problem with the system in the brain that connects us consciously into our bodies, leaving sufferers unable to access their bodies properly. Because it doesn’t show up on scans and tests it is often not diagnosed effectively, and patients can face difficulties accessing the help they need or even being believed that their symptoms are real.

Claudia Hammond sits in on a consultation at the Maudsley Hospital between Emma, a new patient who is having exactly those problems, and Mark Edwards, Professor of Neurology and Interface Disorders at King’s College London.

She also meets Callum Alexander, a recovered patient who now volunteers for the charity FND Hope. He was referred by Mark for specialist neurophysiotherapy with Glenn Nielsen at St George’s University Hospital, which had immediate results. Glenn tells us that FND can cause the brain to become excessively focused on actions are normally automatic, such as walking, and that redirecting the brain’s attention can be one way of alleviating it.

Meanwhile, Emma is relieved she finally has a name to put to her condition and Mark is pushing for more positive diagnoses of FND."

https://www.bbc.co.uk/sounds/play/m00237pf
 
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MeSci said:
Functional Neurological Disorder, or FND, is the most common disorder you’ve probably never heard of. Some say it might be as common as MS or Parkinson’s and yet it’s not well known even by many medical professionals. It can cause seizures, paralysis, convulsions and changes in sensation, as well as pain, fatigue and memory difficulties.

It’s caused by a problem with the system in the brain that connects us consciously into our bodies, leaving sufferers unable to access their bodies properly. Because it doesn’t show up on scans and tests it is often not diagnosed effectively, and patients can face difficulties accessing the help they need or even being believed that their symptoms are real.
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Don't know why they settled for this odd framing of the most common disorder you've never heard of, it's not even true, and oh OK this is actually very much on brand for them to lie about this.

But the second paragraph is just absurdly misleading and disqualifying, saying that FND "causes", when actually it's simply the label that is applied to those things when they can't be explained by standard tests. Then of course the ideologues involved apply the exact same reasoning, not showing up on scans or tests, with us saying that makes them invalid.

What a giant load of bullshit. The absolute peak of medical pseudoscience, in the age of AI, invented and promoted almost entirely by MDs. What a bunch of weirdos.
 
Because it doesn’t show up on scans and tests
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Are they not even reading their own literature?

Machine learning classification of functional neurological disorder using structural brain MRI features (2024, Journal of Neurology, Neurosurgery & Psychiatry)

Structural brain MRI features of patients with mixed FND were distinguishable from both healthy and psychiatric control participants, with subtype analyses showing high specificity (0.83) in accurately classifying individuals with functional motor disorder versus healthy controls.
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Structural brain MRI features of patients with mixed FND were distinguishable from both healthy and psychiatric control participants, with subtype analyses showing high specificity (0.83) in accurately classifying individuals with functional motor disorder versus healthy controls.

Again, if it has an objective structural feature then how can it be classified as functional?

They really are tying themselves, and their patients, up in rhetorical knots.
 
Sean said:
Structural brain MRI features of patients with mixed FND were distinguishable from both healthy and psychiatric control participants, with subtype analyses showing high specificity (0.83) in accurately classifying individuals with functional motor disorder versus healthy controls.

Again, if it has an objective structural feature then how can it be classified as functional?

They really are tying themselves, and their patients, up in rhetorical knots.
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'They' seem keen on distinctions between "healthy and psychiatric control" when 'they' view pwFND as entirely in psychological/behavioural terms.

For example, the CBT model of non epileptic seizures used in the CODES trial is that patients have 'anxiety that isn't anxiety.' CODES failed so that's been difficult for them. Their reflections article is an exercise in non reflection. At no point do they refect on whether their view of FND or construct is flawed.

There is, I suspect, perhaps some censorship going on too! For example, I have posted and reposted to the CODES reflection piece my thoughts in calm, polite manner in a Rapid Response. I need to check again but I suspect it has not been posted. I also submitted letter re CODES that got rejected as The Lancet was focusing on Covid at the time. As if that actually made a difference, it was an excuse.

I'm collecting my thoughts later this week and next for an NHS chronic pain psychologists SIG meeting re FND on 9th Oct. I'm leading and it will be interesting to hear what my colleagues are experiencing in their clinics.

Before my leave for surgery etc earlier in the year, I was occasionally meeting chronic pain patients in my clinic with FND labels who had travelled via neurology to us. None of them understood how this helped them. I recall one male pt being told 'it's like between MS and Parkinsons'. And more recently a lady who had had CBT for FND which did not help..... Confused her.

FND can mean all things to all people. Catch all for pretty much anything but it often includes CFS, FMS, movement disorders, and non epileptic seizures etc., with issues for validity, reliability etc. Overtly heterogeneous just like MUS, SSD etc. Entirely unfalsifiable.

The confident claims for definitive ""we know" what it/they are in terms of multiple different conditions, and then little objective reality or coherent thinking. Just like Richard Brown's claims in The Psychologist in 2013 "Explaining the Unexplained". It's just stuff they think is true. Misdiagnosis is to them a minimal triviality. It is seductive to some (patients and clinicians) and it will, I fear, have legs in the way MUS did not. For those that are misdiagnosed there will be, I suspect, minimal access to accountability.

It really does seem incredibly hard for some neurologists (and it seems A&E doctors who are apparently in some quarters handing out FND labels....) to say "I/we dunno...." And to some clinicians and patients it will mean just that, even though the models of treatment are 100% psychobehavioural (as in curable CBT/GET type therapy). So much unethical duplicity straight to the patients face and much confusion. Minimal humility in the face of things we dunno what causes them.

FND adds nothing of clinical or practical value to pt care. Will lead to more referrals and time wasting for pts and NHS. Likely piss pts off when they get wind of it, end up feeling more isolated, marginalised and ashamed. Precisely the opposite of good care.
 
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