Diagnosis of Functional Weakness and Functional Gait Disorders in Children and Adolescents, 2022, West and Shah

Functional neurological disorder is neurological dysfunction not primarily explained by pathophysiologic or structural abnormalities and can present in children and adolescents with limb weakness, gait abnormality, non-epileptic seizures or sensory changes.

In this review article we focus primarily on the diagnosis of functional limb weakness and functional gait disorders, and how to differentiate functional neurological disorders from structural or pathologic neurological presentations of weakness or gait disturbance. Detailed history and attentive observation of a patient outside of the formal neurological examination can be pertinent to identifying inconsistency and incongruency in keeping with functional neurological presentations. Understanding of structural and physiologic neurological pathology is required to identify non-anatomical and non-pathological features consistent with a diagnosis of functional neurological disorder. Diagnosis is made on recognition of positive clinical features of a functional disorder on examination and is not based primarily on exclusion of a pathologic neurological disorder. Specific tests can be performed to elicit pathognomonic findings supportive of a diagnosis of functional limb weakness and gait disorders.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S1071909122000055

 

This obsession with linearity is weird. The idea that a disease should follow a linear script and never deviate from it has no basis in reality, that every step should either be predictable, or assumed to be a positive feature of some imagined principle is completely irrational. Medicine is unable to make the equivalent jump physics did when having to let go of deterministic mechanics and having to accept the probabilistic nature of quantum mechanics. Medicine is instead choosing to hold on to determinism, things have to be predictable, otherwise they are rejected.

The entire problem with "not explained by a known pathology", along with "all tests are normal" is that using tests for other conditions will obviously be negative. This is like saying "we tested you for cancer, therefore you cannot have Parkinson's disease", completely absurd. So what is an arbitrary, irrelevant factor, now becomes central, positive evidence from doing the wrong thing.

Basically it's setting up a series of arbitrary gotchas, derived from imaginary caricatures, and trying to trip the patient, indifferent that those gotchas don't mean anything in real life. This is especially malicious when applied to people who have memory and cognitive issues, it's deliberately using the disability in order to deny it. That's what those "positive features" are: gotchas derived from the idea of failing to prove innocence is evidence of guilt, on the basis of being different from other things, which is a feature of every damn thing in the universe, that's what makes a thing different from another.

Although you have to laugh at the "detailed history and attentive observation". I have rarely seen people so incapable of paying attention to details, it's like ignoring inconvenient details is the main skill they develop, advanced cherry-picking and selective interpretation. They pay attention the way mentalists and psychics do: to con the mark.