Functional neurological disorder, physical activity and exercise: What we know and what we can learn from comorbid disorders, 2024, Reinsberger et al

rvallee

rvallee

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Functional neurological disorder, physical activity and exercise: What we know and what we can learn from comorbid disorders
https://www.sciencedirect.com/science/article/pii/S258998642400039X#b0285

Highlights
  • Physical activity has not been studied in functional neurological disorder (FND).

  • Exercise has been used to successfully treat comorbid disorders of FND.

  • The autonomic nervous system (ANS) may mediate benefits of exercise.

  • Future research must study the patterns of ANS functioning in FND.
Abstract

Functional neurological disorder (FND) is a common neurologic disorder associated with many comorbid symptoms including fatigue, pain, headache, and orthostasis. These concurrent symptoms lead patients to accumulate multiple diagnoses comorbid with FND, including fibromyalgia, chronic fatigue syndrome, postural orthostatic tachycardia syndrome, persistent post-concussive symptoms, and chronic pain. The role of physical activity and exercise has not been evaluated in FND populations, though has been studied in certain comorbid conditions. In this traditional narrative literature review, we highlight some existing literature on physical activity in FND, then look to comorbid disorders to highlight the therapeutic potential of physical activity. We then consider abnormalities in the autonomic nervous system (ANS) as a potential pathophysiological explanation for symptoms in FND and comorbid disorders and postulate how physical activity and exercise may provide benefit via autonomic regulation.
 
Functional neurological disorder (FND) is a common, often chronic neurologic disorder associated with significant distress and disability [1]. The clinical presentation spans a variety of neurologic symptoms, including seizures, weakness and movement difficulties, sensory disturbances, dizziness, and cognitive concerns. With an estimated prevalence of 50 per 100,000, FND is one of the most common diagnoses seen in neurology [2], [3]. FND subtypes tend to co-occur, with many patients with functional seizures also exhibiting motor FND [4]. Common FND-related symptoms include fatigue, pain, headache, and orthostasis [5], [6]. These concurrent symptoms lead patients to accumulate multiple comorbid disorders, including fibromyalgia, chronic fatigue syndrome, and postural orthostatic tachycardia syndrome.
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Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is an incompletely understood illness manifested by post-exertional fatigue, cognitive issues, sleep disturbances, and/or chronic pain. According to the Centers for Disease Control (CDC), CFS affects up to 2.5 million Americans [51]. Patients with CFS exhibit a 40 % reduction in activity as measured on natural history actigraphy [52]. Specialty clinics for CFS have reported that 84 % of patients over time develop at least one comorbid functional or psychiatric condition [17], [51], [52].
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The best available research on treatment for CFS comes from the 2011 Pacing, graded Activity, and Cognitive behavioral therapy (PACE) trial, a RCT that showed that individualized graded exercise therapy (GET) in conjunction with CBT was most effective at reducing fatigue and improving physical function after one year [53]. GET uses principals of starting with low-intensity activity and gradually increasing based on patient tolerance, as was shown to be effective in FBM. Since the 2011 trial, many other studies have shown that graded exercise therapy improves quality of life, ability to work, physical functioning, anxiety, and depression [54], [55]. Synthesis of the Physiotherapy Evidence Database (PEDro) showed that there is moderate evidence that exercise can improve fatigue, sleep, physical functioning, and overall health in patients with CFS who are well enough to attend an outpatient clinic, irrespective of type of exercise [51], [55].
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Importantly, the PACE trial showed that GET was more effective than adaptive pacing therapy (APT, or pacing). Pacing is promoted as an energy conservation strategy of restricting exposures to post-exertional malaise-inducing stimuli and reducing daily activities [51], [53]. In 2021, the United Kingdom’s National Institute for Health and Care Excellence (NICE) published new CFS treatment guidelines, which favors pacing over GET and CBT. FND and CFS experts have published their serious concerns with the new NICE guidelines, arguing that pacing may actually be harmful to CFS care [56], [57]. All in all, though it remains controversial in light of the new guidelines, the most effective and studied treatment for CFS appears to be GET and CBT, and their success in CFS should prompt application in patients with FND.
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They use the words but they don't understand what any of them mean. It's all just amounting to a sort of jumble where words are irrelevant, concepts cross over and reality simply doesn't matter.

It shows how the concept of FND is nothing but an overarching layer, of ye olde conversion disorder, laid on top of the common discriminated chronic illnesses. All the same concepts are applied willy-nilly: catastrophizing, kinesiophobia, self-efficacy, beliefs in having an illness. It's all the exact same crap.

This is about as connected to the reality of chronic illness as Reefer madness was to what cannabis does to people. It's all just lurid fantasy and nonsense. It just gets stuck repeating the same nonsense as a century ago. Nothing ever changes, even the fact that they keep saying that they have learned, while showing that they have no intention or ability to do so.
 
Merged
https://www.sciencedirect.com/science/article/pii/S258998642400039X

Functional neurological disorder, physical activity and exercise: What we know and what we can learn from comorbid disorders

Kelly A. Boylan a,b,*, Barbara A. Dworetzky a, Gaston Baslet c, Ginger Polich d,
M. Angela O’Neal e, Claus Reinsberger f,g
a
Division of Epilepsy and Neurology, Brigham and Women’s Hospital, Boston, MA, United States
b
Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
c
Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
d
Department of Physical Medicine and Rehabilitation, Mass General Brigham, Boston, MA, United States
e
Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
f
Division of Sports Neurology and Neurosciences, Mass General Brigham Boston, MA, United States
g
Institute of Sports Medicine, Paderborn University, Warburger Str. 100, 33098 Paderborn, Germany
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Received 25 March 2024, Revised 29 May 2024, Accepted 29 May 2024, Available online 1 June 2024, Version of Record 4 June 2024.


Highlights


  • Physical activity has not been studied in functional neurological disorder (FND).

  • Exercise has been used to successfully treat comorbid disorders of FND.

  • The autonomic nervous system (ANS) may mediate benefits of exercise.

  • Future research must study the patterns of ANS functioning in FND.

Abstract

Functional neurological disorder (FND) is a common neurologic disorder associated with many comorbid symptoms including fatigue, pain, headache, and orthostasis.

These concurrent symptoms lead patients to accumulate multiple diagnoses comorbid with FND, including fibromyalgia, chronic fatigue syndrome, postural orthostatic tachycardia syndrome, persistent post-concussive symptoms, and chronic pain.

The role of physical activity and exercise has not been evaluated in FND populations, though has been studied in certain comorbid conditions.

In this traditional narrative literature review, we highlight some existing literature on physical activity in FND, then look to comorbid disorders to highlight the therapeutic potential of physical activity.

We then consider abnormalities in the autonomic nervous system (ANS) as a potential pathophysiological explanation for symptoms in FND and comorbid disorders and postulate how physical activity and exercise may provide benefit via autonomic regulation.

Keywords
Functional neurological disorder
Physical activity
Exercise
Autonomic nervous system
Psychogenic
 
Last edited by a moderator:
Chronic fatigue syndrome
40 % reduction in activity compared to controls
GET + CBT: reduced fatigue and improved physical function at 1 year [52], [53]

Pacing: use remains controversial

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The recent controversies in chronic fatigue syndrome literature (discussed below) warrants investigation into any potential harm of physical activity and exercise in FBM. The most reported exercise-related adverse event is muscle pain, which as discussed is likely amplified given the prevalence of pain catastrophizing. The incidence of exercise-related adverse events is low, with no serious adverse events reported in clinical studies [31]. This indicates that the benefits of exercise in treating symptoms of FBM far outweigh any potential harm.

---

Physical activity in chronic fatigue syndrome

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is an incompletely understood illness manifested by post-exertional fatigue, cognitive issues, sleep disturbances, and/or chronic pain. According to the Centers for Disease Control (CDC), CFS affects up to 2.5 million Americans [51]. Patients with CFS exhibit a 40 % reduction in activity as measured on natural history actigraphy [52]. Specialty clinics for CFS have reported that 84 % of patients over time develop at least one comorbid functional or psychiatric condition [17], [51], [52].

The best available research on treatment for CFS comes from the 2011 Pacing, graded Activity, and Cognitive behavioral therapy (PACE) trial, a RCT that showed that individualized graded exercise therapy (GET) in conjunction with CBT was most effective at reducing fatigue and improving physical function after one year [53]. GET uses principals of starting with low-intensity activity and gradually increasing based on patient tolerance, as was shown to be effective in FBM. Since the 2011 trial, many other studies have shown that graded exercise therapy improves quality of life, ability to work, physical functioning, anxiety, and depression [54], [55]. Synthesis of the Physiotherapy Evidence Database (PEDro) showed that there is moderate evidence that exercise can improve fatigue, sleep, physical functioning, and overall health in patients with CFS who are well enough to attend an outpatient clinic, irrespective of type of exercise [51], [55].

Importantly, the PACE trial showed that GET was more effective than adaptive pacing therapy (APT, or pacing). Pacing is promoted as an energy conservation strategy of restricting exposures to post-exertional malaise-inducing stimuli and reducing daily activities [51], [53]. In 2021, the United Kingdom’s National Institute for Health and Care Excellence (NICE) published new CFS treatment guidelines, which favors pacing over GET and CBT. FND and CFS experts have published their serious concerns with the new NICE guidelines, arguing that pacing may actually be harmful to CFS care [56], [57]. All in all, though it remains controversial in light of the new guidelines, the most effective and studied treatment for CFS appears to be GET and CBT, and their success in CFS should prompt application in patients with FND.
 
cassava7 said:
They know what they are doing — the second author of the article, Dr Barbara Dworetzsky, was a signatory of White’s paper about the “abnormalities” in the NICE ME/CFS guideline.
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Yep, this is just part of a propaganda blitz of the formal literature, ostensibly from different individuals and groups to give the appearance of independence and consensus.

See also the recent advice on exercise by the Royal College of GPs in Australia. Written by [drum roll] Paul Glasziou, he of Cochrane fame and also a signatory to that paper.
 
I wonder if there's a creation of a spurious schism.

Faction A - the current gaslighting model works fine, no need to reinvent the wheel

Faction B - we need a novel gaslighting model (exactly the same as the current one), so we can have a shiny relaunch

Faction C - time to stop gaslighting. Who do these patients think they are, that we have to invest energy lying? Just accept it's psychosomatic and be grateful
Functional Neurological Disorders: Challenging the Mainstream Agnostic Causative Position 2024 Scamvougeras and Castle

Cue lots of funding, papers, conferences, even new associations, journals, institutions. Lots of jobs and honorary positions, and a whole lot of noise to drown out pesky evidence, science and patient welfare.
 
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