Expanding Access to Specialty Care Using Video-Telehealth: The Case for Functional Neurological Disorder, 2021, Perez

[Andy]

To the editor:
Functional neurological disorder (FND) is a prevalent and costly neuropsychiatric condition receiving renewed interest.1 The renaissance occurring in this field has been catalyzed in part by an emphasis on detecting physical examination signs specific for the diagnosis. Additionally, over the past 2 decades, the first randomized controlled trials providing empiric support for psychotherapy and physical rehabilitation have been published—as well as consensus recommendations for physical and occupational therapies.2 Multidisciplinary treatment programs have also been established—in an effort to meet the needs of this population. Nonetheless, timely access to evidence-based care for patients with FND is limited—with multi-year diagnostic delays in many—an observation linked to poor outcomes.

Here, a case of FND that was diagnosed and managed using video-telehealth during the coronavirus-19 pandemic is presented. The intention is that this case, with a positive outcome, will lend support for the need to preserve the gains that have occurred in leveraging telehealth to increase access to subspecialists.3

Open access, https://www.sciencedirect.com/science/article/pii/S2667296021001191

 

[Trish]

n = 1.

The patient had problems with leg and body tremor a year after back surgery after a car accident. Diagnosed as FND on the basis that she was anxious about setting off the tremors, and prescribed both reading a CBT guide and seeing a psychotherapist, and local physio and felt much better a year later after lots of sessions of both. Plus some highly inapproprate and intrusive questioning by the neuro about childhood trauma and an attempt to diagnose PTSD that she disagreed with.

Seems to me it could be a purely physical problem after the surgery, sorted out with lots of sessions of physio.

The only telehealth bit was the initial diagosis and advice, and a couple of followups, she wasn't treated by telehealth.

 

[Andy]

Perez is one of those trying to establish FND as a thing by writing an avalanche of publications - I read this as an attempt at a barely disguised advert for FND more than anything else.

 

[rvallee]

Additionally, over the past 2 decades, the first randomized controlled trials providing empiric support for psychotherapy and physical rehabilitation have been published

Interesting that they did not name or reference them. I assume one of them is the CODES trial, which if anyone remembers had null results. A null result is evidence, if one does not care about things like substance, and accuracy, or even relevance.

She was seen twice in follow-up virtually (at 4 and 10 months after initial consultation), reporting at both visits that she was “much improved.”

I still do not understand why the alternative medicine has not abused this gigantic loophole yet. Well other than the LP folks anyway. If all one has to do is report a single patient "felt much improved" as evidence, then alternative medicine is clearly very much-evidence based. Millions of people not only find many alternative medicines to be not only acceptable, somehow a standard in BPSland, but will gush about it if asked.

It's honestly weird to make the case for telehealth based on BS psychosomatics. Millions of chronically ill people with "respectable" diseases would also benefit from it. They have also been asking for it. This is just advertisement for the pet ideology.