Functional neurological symptoms as initial presentation of Creutzfeldt-Jakob disease: case series 2022 Gómez-Mayordomo et al

It took a couple of clicks in the timeline bar and the play button in bottom left but they did eventually play for me, despite no login. You can also download the videos if you hover in the upper right of the video.

Having seen them I am none the wiser, particularly with regard to "infantile speech". I showed that one to my wife. She said the speech was very slow, as if the patient was struggling to speak and that the intonations were all in the wrong place and that it would sound very wrong to a native speaker.

The demonstrations of distractable tremors and movement disorders leave me non-plussed. It seems as if the whole concept is predicated on "real" / structural disease having to behave identically each time and everything else is "functional". Eg a spinal cord transection at mid thoracic level causes motor and sensory loss at that level and will examine this way each time.

I'm no expert but brain function relies on complex interneural interactions (with synapse assistance from supporting cell types). Some of this activity happens below conscious level and yet we can promote some things to conscious control. Eg we breathe without thinking, but we can take over rate, rhythm, depth at will (within limits). Other things like pulse/BP not so much, otherwise we'd all have been cured of POTS by the LP.

Why wouldn't these speech and motor capabilities alter variably under the influence of adjacent activity or structural pathology? This idea of rule-in signs being definitive for FND and nothing else seems so bizarre. Sure, let's have a diagnostic category of FND that genuinely isn't conversion / hysteria etc, but instead genuinely attempts to understand network interplay and dysfunction; or variable neurometabolic dysfunction. But how can you propose that any such diagnosis can not be wrong by virtue of a "test" (rule-in signs) and that that means all other investigations must stop? Particularly when you publish examples where this was wrong ("oh no, they just had FND overlay") — not to mention the vast numbers of long haulers being diagnosed with "FND".

Talk about "unhelpful illness beliefs", it's obtuse.

 

It amazes me how they can just gloss over the fact that this stuff is common in disintegrating brains and jump to a psychosocial conclusion. Even a fatal disease will not save you from these vultures pushing SSRIs.

 

I have an idea that they are already awake to what is happening, but the profession is so depressed and burnt out that they don't care.

 

It matches their internal prejudices so they are just fine with it. Its just an extension of what they were taught and further what everyone in medicine has reinforced into them and the fact they have left a trail of destruction of wrong Munchausen and other somatic diagnoses isn't on their radar because there are no consequences for it. The entire system is rotten to the core, you would need to fire 95% of everyone to get rid of it.

 

Here's one thing - if these individuals spending all their time creating a non-illness were in the workforce, or recruitment meant there weren't those who were trained and moved into this area in the first place - then that might be a help.

I just find it astounding you've got staff struggling to actually do real work due to a lack of staff and an increasingly large bunch siloing themselves into positions where they tart around with all this. And that is staff of all kinds - doctors are qualified and then move into their specialisms, no reason if theirs turns out to be a turd they shouldn't help on the shop floor using their skills in an area they can help.

To me it also seems clear that all this type of thing doesn't save any work, reduce costs or staff time and certainly causes huge complications that I bet led to ferreting on paperwork re: 'what happened' far more complex behind the scenes than the authors are making out.

Who/what is this area 'adding' anything to/for? Other than those in it?

 

It should, but I'm not sure that they are really getting it. What they describe as FND could be caused by prion mediated neuronal loss - how is that 'mind' now?

Have these people lost the ability to follow logic, as well as science now?

This is stupid. Take out the word 'functional' - which I'm unsure how even they will be able to define it so that it can be 'true' in all of their statements in this article - and it is basic 'derrh obvious'. Add in functional and what? pathological changes now = functional symptoms [that aren't caused by any pathological changes]?

Smells of covering-up/glossing over when you introduce the word subtle for someone who died of CJD months later, and had a possible CJD diagnosis and enough suspicion to have done half the tests.

I guess the word phenotype in this industry/dept is a hiding word to cover 'not actually functional at all'. Someone needs to pull this area up for misusing language to create ambiguity behind which to hide incompetence.

There is clearly no accountability in the type of people who choose this area - this is weasel words of someone called up in front of the headmaster trying to pretend something that went wrong somehow wasn't actually wrong at all?

 

And this the abstract doesn't propose (thanksfully).

The term FND in its genuin meaning doesn't say anything about causation (though the WHO classification may well).


The term FND in its proper meaning is not to critisize, only when it comes to the implication of the interpretation, that it would be caused by believes, habits asf, only then its not proven, and it might be even unlikely - as it is in the case of CJ indeed wrong.

So the abstract actually does a nice job, as it gives an example of FND not caused by any psychological themes.


I think this accuracy is crucial to keep in mind.

 

There was another case like this reported by Solvasen check woolies library on criticism on conversion disorder.

Looks like fnd is useless and neurologists never learn

 

Some of the latest papers from Jon Stone make it clear that he believes FND with its opt in symptoms and neuroimaging has put hysteria on 21st century scientific footing. He has written about how sad it was that the remarkable work done by the likes of Briquet was lost until it was recovered in the late 1990s (by him and Sharpe presumably)

This is similar to the way Wesseley tried to convince people that ME was just a modern version of neurasthenia.

The idea of hysteria and conversion disorder where thoughts and beliefs can induce physical disease is at the core of FND no matter how they talk about it. The missed diagnosis of CJD is justified because a though induced "overlay" was what they were treating. If you think of it this way it is easier to understand why they are so bent on teasing out all the FND aspects of every disease you have heard of.

 

Trial By Error: Can Functional Neurological Disorder Be an Indication of Prion Disease?

https://www.virology.ws/2022/12/21/...l-disorder-be-an-indication-of-prion-disease/

 

If a patient isn't paying very close attention to what is happening, then how else can they report symptoms which lead to diagnosis? You can't even get a referral from primary care to secondary care, where progressive, fatal diseases are diagnosed without reporting symptoms first to a GP. I'm not sure how medics now want this to go. Should patients now somehow turn up, stay silent and let the doctor carry out objective symptom investigations? Out of the multiple symptoms, a patient could be suffering from, how will the doctor always know which exact subjective symptoms they should query to find out what the patient is suffering from?

Next year FND will be included in the new and first Acquired brain injury and neurological conditions guideline. I can't think of a good reason for it to be included if it amounts to the nonsense I've read on this thread. I sense there will be a rise in medicolegal claims going forward.

 

I can think of one case that sounds like FND that I was once told about. I'll try making a post to hear other people's viewpoints.