What's in a name? [about functional neurological disorder (FND)], 2020, Tolchin et al

Andy

Andy

Retired committee member
There is growing confusion about the nomenclature for the disorder currently known by many names including psychogenic nonepileptic seizures, functional seizures, dissociative seizures, and psychogenic nonepileptic attacks. Clinicians and researchers agree that this condition is a subtype of functional neurological disorder (FND), diagnosed based on history, semiology, and video-electroencephalographic evaluation of typical events. Education and psychotherapy are well-accepted primary treatments.

As demonstrated by the lengthy list of names above, in recent years, the terminology used to communicate the diagnosis to patients and to discuss the disorder in the medical literature has become increasingly fragmented. Well-intentioned but uncoordinated efforts to popularize specific terms – including efforts by the present authors – have only exacerbated the problem. Each term has certain advantages and disadvantages, but the failure to consistently use a single term has led to confusion among all constituencies including patients, caregivers, clinicians, advocacy groups, researchers, and funding agencies.
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Paywall, https://www.epilepsybehavior.com/article/S1525-5050(20)30543-6/fulltext
Sci hub, unable to access at time of posting.
 
The proliferation of names for disorders assumed to be "functional" will continue as long as doctors want to keep their true beliefs about a patient a secret (from the patient), and don't want to spend any money finding out the truth.
 
It's true that it's hard to keep track of so many lies. But there is no confusion because most papers and sources plainly state that you mean conversion disorder, a concept of no scientific merit whatsoever.

Not "well-intentioned", however. You waive that entirely once you decide it is OK to blatantly lie in violation of informed, hell even basic, consent and duty of candor. When you make a lie your starting point, there's nothing but more lying ahead.
 
Of course, there is no possibility that the endless stream of new names and concepts is just a rhetorical smokescreen to avoid having to admit they don't know what they are doing, and the serious harm this inflicts on patients.

No sirree, couldn't possibly be that. :grumpy:
 
Trish said:
How about a new one. Idiopathic seizures. At least that makes it clear they haven't a clue what's causing them.
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At the risk of being an ICD-11 bore:

Idiopathic seizures is an ICD term already coded for in ICD-11, in association with epilepsy and benign neonatal seizures in the Neurology chapter:


Chapter 08 Diseases of the nervous system

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1397288146/mms/unspecified

8A6Z Epilepsy or seizures, unspecified

All Index Terms
  • Epilepsy or seizures, unspecified
  • Cerebral seizures
  • Seizure disorder
  • seizure disorder, so described
  • epilepsy NOS
  • epileptiform attack
  • idiopathic seizure disorder
  • seizure activity
  • seizure syndrome
  • congenital seizure disorder NOS
  • epileptic fit
  • epileptic attack
  • morbus caducus
  • cerebral epilepsy
  • epileptic seizure
  • epileptic convulsions
  • epilepsia
  • cerebral or cortical dysrhythmia
  • idiopathic epileptic
  • epileptic syndrome NOS

and

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1397288146/mms/other

8A6Y Other specified epilepsy or seizures

All Index Terms
  • Other specified epilepsy or seizures
  • Benign focal seizures of adolescence ⇒
    • BFSA - [benign focal seizures of adolescence]
  • Postictal fugue in epilepsy ⇒
  • Postictal amnesia in epilepsy ⇒
  • Benign idiopathic neonatal seizures ⇒
  • Benign partial epilepsy of infancy with complex partial seizures ⇒
  • Benign partial epilepsy with secondarily generalized seizures in infancy ⇒


These "Y" and "Z" coded "Residual categories" are backward mapped to ICD-10's G40 code.


Whereas, ICD-11's:

6B60.4 Dissociative neurological symptom disorder, with non-epileptic seizures

is classified under Chapter 06 Mental, behavioural or neurodevelopmental disorders

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1620688958

and backward mapped to ICD-10's F44.5.


For ICD-11, the various Dissociative neurological symptom disorder subclasses are secondary parented to the Disorders of the nervous system chapter.


In classification systems and in clinical practice, the term "idiopathic" is used in several ways, as is the term "functional" - which is one of the reasons why the WHO/ICD Revision did not choose to use the DSM-5 term "Functional neurological symptom disorder" as the revised term for the ICD-10 category block:

F44 Dissociative [conversion] disorders
 
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