Anaesthesia and the development of functional neurological disorder: A systematic review and case series, 2022, Huepe-Artigasa et al

The FND labelling is obscene. It looks as though a prior psychiatric diagnosis in a patient provides surgeons/anaesthetists with a 'get out of jail free' card when it comes to post-surgery issues.

It's possible that this is actually progress - someone suggesting that some of these FND symptoms might be being caused by anaesthesia. It's a shame it is paywalled.

a Melbourne School of Psychological Sciences, University of Melbourne, VIC 3010, Australia
b Alfred Health, Department of Psychiatry, VIC 3084, Australia
c Department of Anaesthesia, Austin Health, Heidelberg, VIC 3084, Australia
d The University of Melbourne, Department of Surgery, Austin Health, Heidelberg, VIC 3084, Australia
e The University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC 3084, Australia
f The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3084, Australia

 

I am not sure the quote marks indicate that the symptoms may be caused by anaesthesia per se, but that the ‘model’ may be one with causing, precipitating and perpetuating factors directly linked with false illness beliefs of some kind about anaesthesia.

 

It could be, the abstract is unhelpfully vague. Does anyone have access to the paper?

 

I've added tags to some of the threads relevant to Kanaan.

 

'Psychiatric' as in 'psychogenic' as opposed to 'affecting brain function'?

 

Oh dear.

I found this study: it used the Taiwanese health insurance research database, looking at the chances of patients developing epilepsy in the year following operations with general anaesthetic or neuraxial anaesthetic (e.g. epidural). I think it has been done well - patients were matched on age and sex, it's a huge sample, patients with epilepsy risk-factors such as those who experienced traumatic brain injury during that year were excluded.

So, the chance of developing epilepsy was much higher after a general anaesthetic than after neuraxial anaesthetic, and it was the case both for men and for women. There were 38 people with multiple sclerosis in the 230,000+ sample of patients who underwent a general anaesthetic; remarkably, 2 of them developed new-onset epilepsy in the year following surgery.

There's some discussion as to why the risk might be higher in people who had a general anaesthetic. They do not mention the evoking of previous traumatic experiences or heightened suggestibility.
e.g.

So, lots of reasons why the risk of developing new onset epilepsy might be increased after having a general anaesthetic, with those possibilities creating opportunities for research, learning and a subsequent improving of health outcomes. I am aware that epilepsy is different to what is diagnosed as FND, including the "non-epileptic seizures", but perhaps the same mechanisms are operating. At the very least, there are possibilities that are worth looking at and excluding before labelling patients with FND. That FND labelling and associated speculation is harmful, as it damages the patients' credibility without any off-setting benefit of allowing access to effective treatment.

 

Thanks to a member for access to the paper.

The authors do not make clear how long the FND symptoms lasted, which surely is of substantial interest. A number of the published case studies they reference involve short-lived symptoms that occurred upon induction of anaesthesia or upon return to consciousness after the operation. Surely the suggestion that these are FND's need to be treated with a high level of skepticism. There are plenty of accounts of seizures during anaesthesia in the veterinary literature, where, unlike here, dosage and other information is typically reported in great detail and the case studies contribute to guidance on safer administration of anaesthesia.

There's a passing reference to the poor quality of the published case reports and to the medical records but they have not let that get in the way.

Conflicts of interest

That's a lot of people reviewing and editing to produce a report that is so muddled and vague. But, probably the paper achieves what its authors wanted it to do; its purpose may well be related to Kanaan's work providing expert testimony on FND in court.