Diagnosis and management of functional neurological disorder, 2022, Aybek and Perez

A new article about fnd. Is he trying to shift emphasis but I doubt it

Diagnosis and management of functional neurological disorder
BMJ 2022; 376 doi:

https://doi.org/10.1136/bmj.o64

 

There is no end to the number of medical conditions that can be disbelieved, dismissed, and left untreated if FND is now a "rule-in" diagnosis.

 

Second author also contributor to paper discussed here: https://www.s4me.info/threads/the-r...2021-tolchin-baslet-carson-perez-stone.23788/

 

You can see the long list of papers that feature Perez here, https://pubmed.ncbi.nlm.nih.gov/?term=David+L+Perez[Author+-+Full]

Many of them will be both worthless and an attempt to establish FND as a thing through sheer weight of garbage papers published promoting it.

 

Opening with two false statements, that's how you know you're on solid ground. So they're taking the Wessely approach of just pretending they've done the work? Full con, merely expressing confidence and taking it from there. It certainly was very effective at destroying millions of lives for pwME. If their measure of success is how many lives they destroy, they will be very successful at it, we know from precedent.

Although, no, actually the first sentence only had one false statement, it sure is true that treatments are available, it said nothing about them being effective, or even relevant. That's a novel twist on lying. Ahhh, the duty of candor, such pretty words that mean nothing at all. And Clinton was in hot water for his "depends on the meaning of is, is", these people have taken lying and manipulation to an art form.

 

It is revealing that the papers on FND have followed a pattern, dare one say strategy on how to manufacture a disease.

It was presented in 2008 with lots of caveats which were dropped somewhere along the way. Then there was a flood of papers on ways to make the diagnosis palatable to patients.

Next up it was all barely understandable studies using various brain scanners with lots of detail to make your eyes cross on how the machines worked and error numbers to make them seem scientific till the very end where you were faced with a disconnect to brain plastic, changes treat with CBT and physio.

Despite FND being said to exist because there are no physical changes they then found lots of physical changes that showed the physical basis of hysteria, cue papers saying how great 19th century neurologists were and how lucky we are to be rediscovering their work and putting it on a scientific basis - hence the "it is now an opt in disease" This was used to justify more papers on how to get the word out to doctors.

Now the sheer weight of evidence is used as a selling point.

Every single paper has been a confirmation study. Nowhere is an alternative possibility suggested that can't be cured by CBT. They have the certainty you find with alternative medicine. No matter how null the result a positive spin is put on everything.

The real questions are "who is funding this stuff?" and "why is it getting published?" It is like an invasive species which is taking over medicine and smothering it.

 

My question to this forum is this.
How many other conditions are they missing if fnd is a rule in diagnosis?

Genetic myopathies and dystrophies
Mitochondrial disease
Autoimmune conditions especially if they are serum negative.

That's why I think fnd is a useless and dangerous diagnosis especially if further
tests are denied.
It smells of quackery and pseudo science

 

It is quackery and pseudoscience and it is dangerous you are completely correct.

Classic and severe presentations of neurological diseases are probably being diagnosed but there are problems. One paper I read complained that too many cases of myotonic dystrophy were being missed. Since it is genetic and worsens down the generations someone in their twenties is diagnosed and the whole family gets genetically tested. A parent and a grandparent are not told they have it as well. And that was in the days before FND took over the world.

Some diseases like Behcet's disease typically take 7 years to be diagnosed with many of them being told they have CFS.

It is just about acceptable for a doctor to miss some of these diseases in the early days but if they give an FND diagnosis - and will everyone get the opt-in tests before they are told it is FND - then it is very possible no one will ever rediagnose them.

It is never in the patient's interest to be told they have FND no matter what they say.

 

Even some rare and more common neurological diseases with non standard initial presentations have no definite tests or cannot be seen in mri initially until damage is done and symptoms become worst can all be classed as fnd and getting a proper diagnosis will become near impossible.

 

What is brain plasticity and why is important for fnd.

 

Brain plasticity is the ability the brain has to reuse some of its neurons to do a different task if it is needed. After a stroke the neurons which manage speech, say, are destroyed but over time other neurons are repurposed and speech can be regained.

In a more general sense, the brain is continually changing making new connections reinforcing some pathways to make them stronger at the expense of others.

FND uses these facts to underpin their theories but they do not specify in what way they work to cause disease . It is all very well to say that stress or whatever, it is hard to pin them down, uses brain plasticity to cause seizures but they never say exactly why that should happen or what the mechanism could be.

FND uses a known fact abut the brain to give the impression there is a valid basis for their theory but it does not stand up. I go to aromatherapy massage and the scent from the oils is pleasant but I was at a talk from an aromatherapist who said this oil stops pain and this oil does that. Now we know that VOC's from plants (including the perfume) have a slight effect on people but this is stretching it to breaking point. FND does the same.

In certain things dismissed as FND like twisted feet I am sure that physio could help. The massage I get feels like it reminds my nerves where they are meant to go by having a strong touch signal so I do not dismiss it. But none of that validates hysteria or whatever the latest name they use for thoughts causing serious neurological disease, is true.

All expressions of disease come through the body so even if a thought induced that expression they have not proved that only thoughts can do it and there is not some physical process involved. No amount of changing the brain or brain plasticity with CBT and physio can prove FND even if it cures the disease.

 

The theory seems to be flimsy in my opinion.
Reconnections may occur in stroke patients but there is always seems to be after effects and they are not always 100% fine
Similarly for neurological diseases where neurons die usually are never going to get full connections

 

There are books on neuroplasticity. One such would be Norman Doidge's "The Brain that changes itself."

https://www.normandoidge.com/?page_id=1259

If we were'nt a group of cognitively challenged (energy limited thinkers) I'd suggest a book club to discuss this as it does have bearing on how the BPS view chronic illness in general.

The author may know what he's talking about but I think that (much like Oliver Sacks) he might be making much of extreme examples and generalising too freely with little or poor data.

Anyone here with some neurology knowledge? -- I'd love to hear an opinion on the subject.

@Woolie still checks in now and then I think and might have a clue or a place to point to for info.

I think it would be interesting and useful to know where the limits on robust documented science lies in this domain.

 

That brings me to another point why are clinical mri so behind the maximum is about 3T where as experimental mri is about 10T
So imagine how much they can learn about the brain with such high resolution.
.may be they can find the biological reason for fnd

 

They have already found biological reasons for FND. I don't understand the technicalities enough to know if these anomalies are real or the result of bad science but they claim that they have now found the biological basis for FND so have brought hysteria from a theory into the light of modern science.

 

May be researchers have got such a strong belief in their fictious concept nothing will get in their way even if they find something biological. Considering hysteria conversion disorder now fnd has been around for 100 years. Thoughts or repressed trauma can never cause physical symptoms.
If this theory was correct why can't cbt or psychotherapy make the symptoms disappear therefore it's wrong and something else is happening from viruses to toxicity or something wrong with the neurons or brain which can not be seen currently.
The brain must be so complex we may never get to understand it completely.

 

The proof of a psychological cause for FND would be if psychological treatments made it go away with no doubt at all. That does not happen.

 

That's really history of medicine since the year dot. If a physical cause is not found the assumption is always that the disease is purely psychological. It's harming patients and causing trauma and distrust in the profession which should know better. So the years of medical seem to be wasted. We will end up in this myopic nightmare where further knowledge is denied because we have the belief that we know everything but do not