Functional neurological disorder and somatic symptom disorder in Parkinson's disease, 2021, Onofrj et al

[Andy]

Highlights

• Functional Neurological Disorder (FND) and Somatic Symptom Disorder (SSD) can be manifestations of PD and DLB.
• FND/SSD appear at prodromal/early stages of PD, then subside with motor worsening.
• In cognitively impaired patients, FND/SSD may evolve into somatic delusions.

Abstract
The occurrence of Functional Neurological Disorder (FND) and Somatic Symptom Disorder (SSD) in PD was not commonly accepted until recently, despite some evidence that emerged in the pre and early L-Dopa era. More recently, the recognition of FND and SSD were noted to be relevant for the management of PD. FND and SSD appear early in the course of PD, often preceding motor symptoms, may interfere with treatment outcomes, often acquire psychotic features during progression, and are mixed with and often concealed by the progressive cognitive decline. We review the related features from the range of the available reports and discuss theoretical models conceived to explain the potential pathophysiological background of these disorders. Finally, we suggest that FND and SSD should be included among the non-motor symptoms of PD and be considered a prodromal feature in a subset of patients.

Paywall, https://www.jns-journal.com/article/S0022-510X(21)02713-1/fulltext

 

[Cheshire]

Such a nonsense. Don't know where to start...

 

[Amw66]

The Parkinson's pie is big and getting bigger

 

[Sean]

Vultures on steroids. They are going to force this shit onto every single disease. Just watch.

This is what medical zealotry looks like.

 

[spinoza577]

The occurrence of Functional Neurological Disorder (FND) and Somatic Symptom Disorder (SSD) in PD was not commonly accepted until recently ... We review the related features from the range of the available reports and discuss theoretical dmodels conceived to explain the potential pathophysiological background of these disorders

The good news is that when you have SSD in PD, you get a free treatment for FND in PD, too. Some might even call them lucky with PD b/c they might have a non-PD FND which otherwise would never have been recognized, and therefore would never have been treated.

If one compares this with ME, then one must admit that PD is much more difficult to understand, as in ME there is no relationship of disorders in one disorder. Its simply a disorder, though this single disorder might be a disorder without disease (according to recent evolving insights). In so far a better understanding of FND in PD could shed some hope into ME too, but it will probably take enormous theoretical effort alone to develop the terminology. Unfortunately, patients with FND are not always open for concepts, which is hindering the application of the instruments. This might even be the reason for the foreseeable outcome that through treatment of FND in PD also the SSD in PD will not be helped.

 

[Solstice]

Vultures on steroids. They are going to force this shit onto every single disease. Just watch.

This is what medical zealotry looks like.

Hopefully they blow up the entire profession in the process. It needs a reboot to factory settings.

That's honestly my hope in this, that so many people get a look behind the curtains and see the puppetmaster because of the sheer amount of diseases they are forcing this on that there's a major revolt.

 

[rvallee]

The lesson of The boy who cried wolf is that the villagers stopped listening to the boy and everyone got hurt for it, so the lesson is: don't lie.

Sad that medicine can't even rise up to the standard of fables meant to teach kids about not lying, or shunning liars. Too much to ask, I guess.

 

[Mithriel]

If there was any basis to FND and SSD this could be useful but there is not. It sounds vaguely plausible if FND and SSD are accepted as valid disease categories, like migraine or chronic cough and doctors who don't know the background may presume that it must be genuine if someone is funding the work.

But the basis of FND is that someone has neurological symptoms which are "not congruent" that is the examining doctor thinks he knows everything but may not, or there is no physical evidence of disease, because our machines can detect everything wrong in the brain.

The much more reasonable assumption is that early Parkinson's Disease is not recognised very well. When learning about diagnosis my daughter was told that books tell the most straightforward presentations of disease but that real life rarely matches that.

FND and SSD appear early in the course of PD, often preceding motor symptoms,

So it is not recognised until the most obvious symptom appears and the doctor says "Now I see what it is!"

FND and SSD are flooding over medicine like a tsunami and sweeping all before them. All that research into making them sound plausible has paid off. What makes me so angry is that it is a dead end for knowledge. Everything gets treated with CBT and if you don't get better it is because your behaviour is too entrenched for change.

Physio may help since it can encourage new pathways and it does not matter the theory for using it, but the success will be attributed to CBT and no work will be done into what the physio is doing to the brain.