Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective, 2020, Perez et al

[Andy]

Functional neurological disorder (FND), a condition at the intersection of neurology and psychiatry, is a common and disabling outpatient referral to neurology and neuropsychiatry clinics. In this perspective article, we focus on the motor spectrum of FND (mFND), including individuals with functional movement disorders (FND-movt), functional limb weakness/paresis (FND-par) and functional [psychogenic non-epileptic/dissociative] seizures (FND-seiz). Over the past several decades, there have been dedicated efforts within the neurologic and psychiatric communities to create “rule-in” diagnostic criteria, as well as thoughtful approaches to the clinical interview, delivery of the diagnosis and the development of a patient-centered treatment plan. These advances allow the promotion of good clinical practices in the outpatient assessment and management of mFND.

Informed by the literature and our prior clinical experiences, we provide suggestions on how to evaluate individuals with suspected functional motor symptoms - including conducting sensitive psychiatric and psychosocial screenings. Additional sections discuss common “rule-in” neurological examination and semiologic signs of motor FND, as well as approaches to deliver the diagnosis and formulate a treatment plan based on individual patient needs. To aid the development of shared (partially overlapping) expertise that catalyzes an interdisciplinary approach to mFND, the use of physiotherapy for therapeutic motor retraining and cognitive behavioral therapy to examine relationships between symptoms, thoughts, behaviors and emotions are also discussed. Additional clinical research is needed to further refine and operationalize the assessment and management of mFND, across clinics, healthcare settings and countries.

Open access, https://www.dovepress.com/towards-a...rological--peer-reviewed-fulltext-article-NDT

 

[rvallee]

Delusional

 

[dave30th]

The senior author, David Perez in Boston, wrote the commentary accompanying the CODES trial that substituted his clinical experience as providing evidence for the benefits of CBT in treating so-called "dissociative seizures," even though the findings of the trial found the opposite.

 

[alktipping]

a correction it should read misinformed by the literature . building your theories on wishful thinking only causes harm .

 

[Mithriel]

I have said this before but it repays repeating. Myotonic dystrophy is the commonest adult onset muscular dystrophy. It is genetic and caused by repeats of base pairs so it tends to be worse down the generations.

When someone in their 20s say tests positive other members of the family get tested too, and it is not uncommon for people to be found who have the gene but whose ill health for years has gone undiagnosed because they now know the disease does not always present in its "classic" form.

How many of them have been told they have FND and do they do genetic testing on everyone before they say it is FND? There are all the channelopathies to test for too.

The first paper by Sharpe and Stone on FND said that care must be taken with motor disorders because they are very hard to diagnose properly but that has been lost over the years.

Oh, by the way, the classic trio of myotonic dystrophy symptoms are myotonia, frontal balding and cataracts with weakness and lots of strange things going wrong like acid reflux, IBS and diabetes. How many people are going to be told they have FND if they do not get the right doctor initially?