Nonepileptic attack disorder and functional movement disorder: A clinical continuum?, 2020, Cavanna and Rather

Andy · Mar 24, 2020

Nonepileptic attack disorder (NEAD) and functional movement disorder (FMD) are functional neurological disorders commonly seen in neuropsychiatry services. Although their initial referral pathways involve epileptologists (NEAD) and specialists in movement disorders (FMD), these conditions are currently classified as two possible manifestations of a single underlying conversion disorder.

We set out to compare the characteristics of patients with NEAD and patients with FMD in order to quantify the degree of overlap between these patient groups. We retrospectively reviewed comprehensive clinical data from 146 consecutive patients with functional neurological disorders (NEAD: n = 117; FMD: n = 29) attending a specialist Neuropsychiatry Clinic run by a single Consultant in Behavioral Neurology. The two clinical groups were directly compared with regard to demographic and clinical characteristics, as well as somatic and psychiatric presentations.

The results showed that in most features, there were no significant differences between patients with NEAD and patients with FMD. However, patients with NEAD reported an earlier age at onset (p = 0.033) and a higher proportion of acute onset (p = 0.037), alterations of consciousness (p = 0.001), and headache (p = 0.042), whereas patients with FMD reported a higher prevalence of childhood abuse (p = 0.008), as well as mobility problems (p = 0.007) and comorbid functional symptoms (dysarthria, p = 0.004; dizziness, p = 0.035; weakness, p = 0.049). Despite different phenotypic presentations, NEAD and FMD might represent a clinical continuum, with relevant implications in terms of both diagnostic strategies and treatment approaches.
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Paywall, https://www.epilepsybehavior.com/article/S1525-5050(20)30207-9/fulltext
Not available via Sci hub at time of posting.

Arnie Pye · Mar 24, 2020

I used to have a problem with my muscles locking up - mainly my shoulders and jaw. I could consciously relax them but as soon as I stopped thinking about relaxing my muscles they would lock up again.

I've also had a problem for most of my life where my eyelid(s) or sometimes larger muscles would twitch and it wasn't under my conscious control. I couldn't stop benign fasciculations from happening (for example).

Since I started supplementing with magnesium and improved my basic nutrient levels both these problems have become a thing of the past.

Is it possible that non-epileptic seizures might be related to low nutrient levels?

https://en.wikipedia.org/wiki/Psychogenic_non-epileptic_seizure

It seems to me that doctors rarely if ever consider nutrient deficiency as a cause of anything. There is always an assumption that people eat well, even though we only have to look at some cultures and societies to see that simply isn't true.

Hutan · Mar 25, 2020

The two clinical groups were directly compared with regard to demographic and clinical characteristics, as well as somatic and psychiatric presentations.
Click to expand...

The results showed that in most features, there were no significant differences between patients with NEAD and patients with FMD.
Click to expand...

What a shame they didn't have groups of people with epilepsy and rheumatoid arthritis to question as well. Then, if there were no differences in 'most features' between all four, the authors could assume that NEAD and FMD and epilepsy, despite 'different phenotypic presentations' are three possible manifestations of rheumatoid arthritis.

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Nonepileptic attack disorder and functional movement disorder: A clinical continuum?, 2020, Cavanna and Rather

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Nonepileptic attack disorder and functional movement disorder: A clinical continuum?, 2020, Cavanna and Rather

Andy Committee Member

Arnie Pye Senior Member (Voting Rights)

Hutan Moderator Staff Member

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