Functional neurological disorder in multiple sclerosis: A prospective study, 2025, Cuoco et al.

Functional neurological disorder in multiple sclerosis: A prospective study
Cuoco; Scannapieco; Barra; Giordano; Gregorio; Barone; Erro

BACKGROUND
There is increasing recognition Functional Neurological disorder (FND) is comorbid with other neurological conditions, but little is known about patients with Multiple Sclerosis (MS). We therefore systematically evaluated the presence of FND in consecutive patients with MS and its clinical correlates.

METHODS
Three-hundred and ten consecutive MS patients, seen at our center on either elective or emergent basis, underwent a structured protocol to gather demographics and data about clinical features, previous and current treatments and presence of mood disorders and were additionally assessed by an expert in FND. Patients with and without FND were then compared to identify clinical correlates with the functional comorbidity.

RESULTS
Overall, we found that 5.8 % of patients with MS had comorbid FND. Of note, 22.6 % (7/31) of MS patients admitted on an emergent basis for a suspected relapse were found to have incident FND. Patients with comorbid FND had higher rates of clinically significant mood disturbances and a higher number of previous therapeutic switches due to treatment failure or to side effects than patients without FND. Depression, relapsing remitting MS and disability were found to independently predict the presence of FND.

CONCLUSIONS
FND is relatively frequent in patients with MS. As the two conditions might have similar phenomenological presentations, it is important to properly screen and recognize FND because of crucial treatment implications.

Link (Multiple Sclerosis and Related Disorders)

 

Note the keywords are: "Conversion disorder, Depression, Mood disorders, Pseudo-relapses, Psychogenic".

 

They are just clutching at straws.

'A more recent study also found that in about 17 % of MS patients, the clinical symptoms, including pain and fatigue, could not be entirely explained by the underlying structural pathology, hinting at the possibility of a functional comorbidity (Piliavska et al., 2023). Similarly, another study found that in a substantial proportion of MS patients with acute neurological manifestations, there was a clinical-radiological mismatch that could be also explained by a psychosomatic component '

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This is depressing, because it indicates that the psycho lobby will not stop even if we find a biomarker, and treatments for some patients.

 

From the group that brought you Attachment styles, identification of feelings and psychiatric symptoms in functional neurological disorders (2021, Journal of Psychosomatic Research)

I don't understand how the EDSS score would be revised down simply by deciding it's due to FND. They either have impairment in functional systems or they don't. I guess they're implicating The Brain with FND (ie the mind-brain-body interface) rather individual neurological systems: pyramidal, cerebellar etc.

So if the MS treatment doesn't work, it's not the doc's fault, it's you. Oh and also you're not akshully as disabled as you thought you were. See, our score says so.

 

THIS all day, every day!

I had a brother and sister-in-law (siblings) of my late husband who had severe eczema as young children who both went on in later life to develop both types of MS, progressive and relapsing and remitting. Both were dead by 45 years old. My husband (their older brother developed psoriasis late in life and died of cancer).

I know all this because I also grew up with them and none of these diagnoses were self reported.

My brother had the same extent of eczema as a young child and I had psoriasis. He now has prostate cancer the same as our late father who also had akylosing spondilitis and I have lifelong psoriasis and now ME/CFS. My mother didn't develop psoriasis until late in life.

When my dad was told he had weeks left to live his head dropped and he held my hand. The Consultant irritatedly snapped at my dad telling him 'not to be so depressed'. I snapped back at her and demanded to know why she felt she had the right to dictate to my dad how he should feel about what she just told us!

The nurse took us to another room and advised my dad of his right to request another consultant for his end of life care, which he did. That was 2009. I can't help but wonder whether the nurse would do that today.

When, when are the medical profession going to stop treating patients like this and really get back to LISTENING to them and taking a FULL FAMILY HISTORY and then following the evidence, instead of creating empires of eminence based on their favourite theory with no responsibility or accountability!

Rant over, and a period of calm analysis of evidence will resume shortly.

 

Oh @Maat. I don’t have words.

Your father deserved better.

 

Yes he did, and he received better from the other consultant. We all deserve better.

However, and this is the only reason I would ever say this, I'm glad he didn't survive another five years otherwise he would have been referred to the fatigue clinic for cancer related fatigue and been 'treated' by the same clinic lead as I was when it was previously the CFS/ME Management Clinic. He would have implicitly believed and trusted, just as he taught me to. I don't now.

 

Aaargh
I have no words