Misdiagnosis of functional neurological symptom disorders in paediatrics: Narrative review and relevant case report 2024 Baglioni et al

Abstract

Functional neurological symptom disorders (FNSD) pose a common challenge in clinical practice, particularly in pediatric cases where the clinical phenotypes can be intricate and easily confused with structural disturbances. The frequent coexistence of FNSDs with other medical disorders often results in misdiagnosis. In this review, we highlight the distinctions between FNSD and various psychiatric and neurological conditions. Contrary to the misconception that FNSD is a diagnosis of exclusion, we underscore its nature as a diagnosis of inclusion, contingent upon recognizing specific clinical features.

However, our focus is on a critical learning point illustrated by the case of a 14-year-old male initially diagnosed with FNSD, but subsequently found to have a rare primary monogenic movement disorder (paroxysmal kinesigenic dyskinesia, PKD). The crucial takeaway from this case is the importance of avoiding an FNSD diagnosis based solely on psychiatric comorbidity and suppressible symptoms. Instead, clinicians should diligently assess for specific features indicative of FNSD, which were absent in this case. This emphasizes the importance of making a diagnosis of inclusion. Extended follow-up and clinical-oriented genetic testing might help identify comorbidities, prevent misdiagnosis, and guide interventions in complex cases, which cannot be simply classified as “functional” solely because other conditions can be excluded.

Paywall, https://journals.sagepub.com/doi/10.1177/13591045241240805

 

This is really the whole issue with this ideology. They can only find out that they are wrong by finding what's actually right, and it's defined explicitly on not knowing what's wrong, and deciding it must be that. It's like having students grade their own exam without an answer sheet right after finishing it. How can they know what's the actual correct answer, and how could it be, to them, anything but the answer they put thinking it's probably correct as far as they know? Who gives a wrong answer on purpose? No one. But this is their entire model for finding out whenever they're wrong, and that's not even counting when some of them simply pull the magical "functional overlay" rabbit out of the hat when they're shown to have been wrong.

Unfalsifiability. This is the essence of science. Russel's teapot. These people are working outside the bounds of science and can only be corrected when those bounds catch their mistakes, having constructed their entire ideology with the intent of not finding out (it's costly and scary, is what they say). The entire construct is wrong for this reason alone. Not only are they harming people, it has delayed the progress of medical science.

They really are skirting the truth here, but are unable to actually go for it. Even after a full century of pushing this, they can't handle uncertainty correctly.