Functional Neurological Disorder (FND) - articles, social media and discussion

[SNT Gatchaman]

Apropos of nothing —

A neural network for religious fundamentalism derived from patients with brain lesions (Aug 2024)
Ferguson, Michael A.; Asp, Erik W.; Kletenik, Isaiah; Tranel, Daniel; Boes, Aaron D.; Nelson, Jenae M.; Schaper, Frederic L. W. V. J.; Siddiqi, Shan; Turner, Joseph I.; Anderson, J. Seth; Nielsen, Jared A.; Bateman, James R.; Grafman, Jordan; Fox, Michael D.

SIGNIFICANCE
Religious fundamentalism is a global and enduring phenomenon. Measuring religious fundamentalism following focal brain damage may lend insight into its neural basis. We use lesion network mapping, a technique that uses connectivity data to identify functional brain networks, to analyze two large, independent datasets of brain lesion patients. We found a network of brain regions that, when damaged, are linked to higher religious fundamentalism. This functional network was lateralized to the right hemisphere and overlaps with the locations of brain lesions associated with specific neuropsychiatric and behavioral conditions. Our findings shed light on neuroanatomy that may influence the emergence of religious fundamentalism, offering implications for understanding the relationship between brain networks and fundamentalist behavior.

ABSTRACT
Religious fundamentalism, characterized by rigid adherence to a set of beliefs putatively revealing inerrant truths, is ubiquitous across cultures and has a global impact on society. Understanding the psychological and neurobiological processes producing religious fundamentalism may inform a variety of scientific, sociological, and cultural questions. Research indicates that brain damage can alter religious fundamentalism. However, the precise brain regions involved with these changes remain unknown. Here, we analyzed brain lesions associated with varying levels of religious fundamentalism in two large datasets from independent laboratories. Lesions associated with greater fundamentalism were connected to a specific brain network with nodes in the right orbitofrontal, dorsolateral prefrontal, and inferior parietal lobe. This fundamentalism network was strongly right hemisphere lateralized and highly reproducible across the independent datasets (r = 0.82) with cross-validations between datasets. To explore the relationship of this network to lesions previously studied by our group, we tested for similarities to twenty-one lesion-associated conditions. Lesions associated with confabulation and criminal behavior showed a similar connectivity pattern as lesions associated with greater fundamentalism. Moreover, lesions associated with poststroke pain showed a similar connectivity pattern as lesions associated with lower fundamentalism. These findings are consistent with the current understanding of hemispheric specializations for reasoning and lend insight into previously observed epidemiological associations with fundamentalism, such as cognitive rigidity and outgroup hostility.

Link | PDF (Proceedings of the National Academy of Sciences)

 

[hotblack]

It really does seem incredibly hard for some neurologists (and it seems A&E doctors who are apparently in some quarters handing out FND labels....) to say "I/we dunno...."

That’s a good explanation of something that I recently realised seems prevalent and involved in many of the problems we see.

Saying ‘I don’t know’ can be hard for all of us. Even more so for people who want to help and/or feel very highly of their own ability and/or feel a pressure to know/help.

But saying we don’t know something is brilliant. It’s the necessary first step in an admittedly often long road to learning. And above all it is honest.

 

[Arnie Pye]

FND can mean all things to all people.

Agreed. And to patients and journalists, CBT is just a single amorphous lump of a treatment that can be used for everybody with any kind of health problem. There seems to be little realisation that there are different flavours of CBT for different purposes.

Not that that made any difference to me. I was referred for CBT about 15 years ago and it was utterly useless. My health problems at the time all had a physical origin e.g. untreated hypothyroidism and iron deficiency, but I ended up treating them myself in the end. And surprise, surprise the things I was sent to CBT for were correctly treated as a result of my self-treatment. CBT did not fix them.

Edit : Grammar

 

[rvallee]

Structural brain MRI features of patients with mixed FND were distinguishable from both healthy and psychiatric control participants, with subtype analyses showing high specificity (0.83) in accurately classifying individuals with functional motor disorder versus healthy controls.

Again, if it has an objective structural feature then how can it be classified as functional?

They really are tying themselves, and their patients, up in rhetorical knots.

Amazing what one can do when there is no oversight or accountability and you can just make stuff up.

 

[rvallee]

It is clear that a large chunk of the medical profession don't have a freaking clue about how much this FND lark is going to cost their reputations when the shit inevitably hits the fan.

The joys of being in an industry that isn't subject to supply and demand pressures, and in fact you have 10x more demand than supply so you never have to actually bother producing good outcomes beyond whoever supervises/funds you wants out of you.

It does cost them a lot of credibility. But it makes zero difference on their day-to-day operations. None that they can see anyway. Having fewer customers is the best outcome they can hope for, they can even pretend that it means they're doing great when patients don't come back. In fact they routinely do. Looping back to my comment #16 above.

 

[rvallee]

Religious fundamentalism, characterized by rigid adherence to a set of beliefs putatively revealing inerrant truths, is ubiquitous across cultures and has a global impact on society. Understanding the psychological and neurobiological processes producing religious fundamentalism may inform a variety of scientific, sociological, and cultural questions. Research indicates that brain damage can alter religious fundamentalism. However, the precise brain regions involved with these changes remain unknown. Here, we analyzed brain lesions associated with varying levels of religious fundamentalism in two large datasets from independent laboratories. Lesions associated with greater fundamentalism were connected to a specific brain network with nodes in the right orbitofrontal, dorsolateral prefrontal, and inferior parietal lobe. This fundamentalism network was strongly right hemisphere lateralized and highly reproducible across the independent datasets (r = 0.82) with cross-validations between datasets. To explore the relationship of this network to lesions previously studied by our group, we tested for similarities to twenty-one lesion-associated conditions. Lesions associated with confabulation and criminal behavior showed a similar connectivity pattern as lesions associated with greater fundamentalism. Moreover, lesions associated with poststroke pain showed a similar connectivity pattern as lesions associated with lower fundamentalism. These findings are consistent with the current understanding of hemispheric specializations for reasoning and lend insight into previously observed epidemiological associations with fundamentalism, such as cognitive rigidity and outgroup hostility.

Hypothesis: we would likely see similar things from MDs who believe in psychosomatic models.

People get out of fundamentalist ideologies. This isn't a rigid construct in the structure of the brain, has nothing to do with genetics or any fixed conditions. It's a dynamic process. And just as other forms of fundamentalism require deprogramming, the same will be needed for psychosomatic ideology. This is likely why it's so hard to move past it. It's too deep and affects their core identity.

 

[DigitalDrifter]

Likely pee pts off when they get wind of it

I'm reminded of that Simon Wessely quote where he says: For as long a psychiatry exists in the public imagination as it does now, then each generation will find it necessary to discover its own ME.

What he doesn't say is that the reason the names keep changing is because patients realize the label has been hijacked to mean not real.

My response: For as long as medical professionals continue to psychologize unexplained physical illness, each generation will invent their own ME.
The truth:

https://www.reddit.com/r/JuniorDoctorsUK/comments/13n9yf7/comment/jkyerip/

 

[MeSci]

Merged thread

My GP told me to get moving after I was paralysed ('FND')

https://www.bbc.co.uk/news/articles/ckgxd88lgy4o

"A man who was left unable to walk or talk by a neurological disorder has called for greater understanding of his condition after he was told to "get moving" by a GP.

Liam Virgo, 22, was 13 when he was diagnosed with functional neurological disorder (FND), which affects how the brain sends and receives information to and from the body.

He was left bedbound for three years by the condition, but is now making a slow recovery and learning to walk again."

(I wonder...)

 

[Ash]

FND really is following in CFS footsteps isn’t it?
Where the researchers and clinicians who came up with it spread stigma far and wide limiting seeds on the breeze.

Then the FND researchers, well inventors or rather re-cyclers if we’re quite honest, publicly complain about this stigma, blamed on some unknown party, this that means other doctors are mean to their (FND) patients, but only we’re told because of these doctors not understanding the construct that our FND researchers have invented.

All problems, and poor patient outcomes, the fault of everyday doctors.
In ignorance of what?
The specifics around FND?
This ruins everything.
They ruin everything.

Except there is nothing to know. There are no specifics . Just knowing that there is no there there. The stigma is built in. There’s no escape. The FND.

I’m so glad many patients recover well from this ordeal. But I really fear for those who don’t. How many people are killed by doctors who saddle them with a ‘no further investigation diagnosis?’


We know what happens to people with ME which is also sometimes greedily devoured by FND researchers. It’s not good. Premature death is going around.

 

[Yann04]

I have a friend who was diagnosed with FND which ended up being MS. They said discussing the whole thing with someone skeptical of the concept made them feel validated of their aversion to that label they were given. They also asked if there are any writings critical of FND I could send them. Anyone know something I could send?

 

[Utsikt]

I have a friend who was diagnosed with FND which ended up being MS. They said discussing the whole thing with someone skeptical of the concept made them feel validated of their aversion to that label they were given. They also asked if there are any writings critical of FND I could send them. Anyone know something I could send?

Tuller has writen a lot about it:

https://www.google.com/search?q=sit...wQYASBf&hl=nb&sourceid=chrome-mobile&ie=UTF-8

 

[DigitalDrifter]

Anyone know something I could send?

https://jnnp.bmj.com/content/83/3/248

One advantage of ‘functional’ may thus be as a simplifying euphemism, allowing neurologists to use the same term to mean one thing to colleagues and another to patients. It may be precisely this ambiguity which has allowed the construct to survive despite the uncertainty and conflicts underpinning its meaning at any point in time.

 

[MeSci]

Merged thread

'I went into hospital for four days and came out two years later (FND)

Megan Dixon was 13 years old when she started feeling unwell.

By 16, her health had deteriorated to such an extent that she was taken to hospital after losing the ability to speak. Doctors believed she may have had a stroke.

She had only been due to remain there for four days for tests, but came out two years later completely paralysed. Unable to walk, talk or open her eyes, she was told she would never move again.

Megan was diagnosed with Functional Neurological Disorder (FND), which meant there was a problem with how her brain received and sent information to the rest of the body.

https://www.bbc.co.uk/news/articles/cx2x13k170do

 

[Jaybee00]

Contractions in the knees? Is that an ME/CFS symptom?


“
She said: "I can move everything now. Obviously I can talk, I can see. I can't walk and I'm never going to be able to walk again, but that's because I've got contractions in my knees.

"I need surgery in order to bend them because my legs are stuck straight. It's very painful, but I'm waiting on surgery, and it means I'm never going to be able to walk again.”

 

[Cinders66]

To be honest it sounds very m.e type but no post-exertional malaise mentioned so unclear. Everything else I’ve heard of in severe me. I have contractures in my ankles and know someome else with LC/ME in their knees and we would tbf be devastwd if surviving the horror of severe ME amd Hanging on through the dark ages of scorn and neglect to be given some form of treatment for m.e but never be able to walk again.regarding contractures Afaiu well known risk & management is t always simple. Jessica Taylor ,a famous severe case, with similar age to this girl , deterioration into zero function , had to have her arms splinted and required surgery on improving and there was girl decades ago featured on the Esther rantzen m.e tv program who had a badly contractured hand drs would not believe she could not move. She posted years later that was a lot better on Facebook but I was sad to see her hand still twisted

 

[Yann04]

To be honest it sounds very m.e type but no post-exertional malaise mentioned so unclear.

To be fair, especially if you only experience delayed, it’s probably not uncommon to not really realise PEM is a thing. Especially if you’re in rolling PEM.

 

[Kitty]

Contractions in the knees? Is that an ME/CFS symptom?

No, but I guess anyone could get contractures from very prolonged immobility?

 

[Cinders66]

No, but I guess anyone could get contractures from very prolonged immobility?

for me the issues are not just arising from immobility, but I think hyper Tone, spasticity, the type of issues seen in neurological conditions. I get a lot of muscle issues all over, including facial grimaces and the bent arms, claw hands, we see when people have neuro injury but it's my ankle feet that are worst as I can hardly ever move my left foot. I can't say this conclusively as I have no medical care and have had little time with neurologists. The nhs gp etc were keen to put it down to immobility but I don't think so & I have had nhs physiotherapists diagnose hypertonic muscles. https://www.wsh.nhs.uk/CMS-Document...agement-advice-positioning-for-spasticity.pdf

 

[Jonathan Edwards]

I am not aware that spasticity has ever been recorded in the context of ME/CFS. It implies a structural upper motor neuron problem and that has not been reported in ME/CFS. Contractures will occur with prolonged postures - chiefly plantar flexion of feet and flexion of knees. Spasticity tends to force knees into extension.

 

[Sasha]

I am not aware that spasticity has ever been recorded in the context of ME/CFS. It implies a structural upper motor neuron problem and that has not been reported in ME/CFS. Contractures will occur with prolonged postures - chiefly plantar flexion of feet and flexion of knees. Spasticity tends to force knees into extension.

I remember reading (in an Action for ME magazine, I think) about 35-40 years ago an account by a man of his wife with ME whose hands kept contracting so badly that she had to have her fingers broken. I may be misremembering that, and of course she may have been misdiagnosed with ME or the hands issue may have been separate. I don't think I've heard of a similar case since.