Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda, 2021, Perez, Carson, Edwards, Hallet, Stone et al

Another production from the FND paper factory...

Highlights

• 1st Neuroimaging Workgroup Meeting in Functional Neurological Disorder (FND).
• Underscores the importance of FND cohort characterization in brain imaging research.
• Details methodological approaches taken in FND neuroimaging research to date.
• Research agenda proposed to definitely elucidate the neural circuitry of FND.
• Discussions underway regarding having FND researchers join the ENIGMA consortium.

Abstract

Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart – leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using “rule-in” examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field.

Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis.

Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.

Open access, https://www.sciencedirect.com/science/article/pii/S221315822100067X

 

This is what I was afraid of. They gave cloaked the pseudoscience round with so much modern terminology and buzzwords that the central underlying problem - they have never outlined, never mind tested, a plausible mechanism for how emotions affect neurons.

 

I don't understand how people can debase themselves this way. Just shameless lying and misrepresentation without consequences. But of course the answer is simple: they are rewarded for it. So the people really responsible for this are the bystanders too cowardly to point it out. It's a proper Big Lie. Everyone knows it's a lie, they just don't care enough about what's right to do something about it, would rather not rock the boat.

 

This group seems to be putting in more effort than some others.

I'd like to say though I don't know much about this I don't think that neuroimaging will turn out to be the definitive tool for understanding the pathology of most or even all MUS.

And they will never be able with this model to call any pyschological therapy curative. Brain plasticity does not support that idea as far as I can tell. And in things like stroke it is not psychological therapies but physical therapies that have improved function.

It would be good to get a better understanding of what is thought to be understood about brain plasticity. I found the following link but there may be better one's out there:

https://theconversation.com/what-is-brain-plasticity-and-why-is-it-so-important-55967

 

Thing is, whenever something shows up on any tests the most common reaction is how this must mean it's not "functional" after all, since by definition functional means no abnormality should show up.

This is interesting, though, to pretend that there is physiological evidence for something defined by having no physiological evidence. It's almost like a loyalty test, to test the limits of how absurd can things get before people stop pretending.

I don't think this group is putting in any effort on this, it would eventually mean the end of their ideology. They are simply in the process of selling the cake they are eating. They're basically just throwing fake "neuroscience" buzzwords as if they mean anything.

 

https://www.youtube.com/watch?v=SDRzlGfrDrQ

Perez the one who said that he will continue CBT for epilepsy even though a study showed it was ineffective.

Doesn’t really define the symptoms of FND as far as I read, but admits that it used to be called hysteria.

 

Also brutal peer review.

Received 16 February 2021, Accepted 3 March 2021, Available online 11 March 2021.

 

Flat earth society?

 

Sorry, I'm lost. What has been given a brutal peer review?

 

Thanks for the explanation, @Hutan .

 

Yes, close--he said that in relation to CODES, the study of CBT for psychogenic non-epileptic seizures (PNES) because he knows it works from his clinical practice.

 

So...have I got this right: FND the same as, or as near as possible to MUS has been studied using neuroimaging. Abnormalities have been found using neuroimaging, but even with physiological evidence these conditions are still labeled FND.

If this is the gist, then it might not be long until all diseases are labeled FND/MUS?

Back to square one with things like cancer and heart disease treatment then.

 

@Hutan's right, @DokaGirl. It's not difficult to find differences on fMRI measures between any clinical group and healthy people, especially not if you cast the net wide (that is, sweep the whole brain and only report the differences). Generally speaking any group that is different to any other in any way - physical or otherwise - will show some differences somewhere, whether its differences in task-related activity in some part of the brain, or whether its differences in the coherence of activation within different brain networks.

Its just that you can't infer what causes those differences. Finding differences neither shows something is organic, nor does it show something's "psychogenic". Its an observation in search of an explanation.

To demonstrate how messed up all this is, here's an example. There's been a lot of research showing that people diagnosed with major depressive disorder show abnormalities on certain fMRI measures that are taken "at rest" (when the person is lying in the scanner with their eyes closed and headphones on). Specifically parts of the "default mode network (DMN)" are more actively communicating. Because this network includes structures known to be involved in autobiographical memory (e.g., the hippocampus), people have claimed that the abnormality reflects "excessive rumination". That is, neuroscientific proof that these folks are caught up in a cycle of negative thoughts.

Its as stupid as hell, because in the brain, "rumination" is indistinguishable from any other form of internal thought/reflection. What these researchers have done is a whole lot of fancy neuroscience, but instead of listening to what that data was actually saying, they just superimposed their own preconceptions directly onto it. Used it to "prove" what they already "know".

Its just as likely that people with depression are overengaging their DMN as a way to compensate for the extreme demands placed on them, coming into the hospital and being subjected to the scan.

Neuroscience bullshit is one of the most evil types of bullshit, because its very tricky to spot it.

 

@Hutan @Woolie

Thank you for your explanations. I think I understand: these practitioners label what they see in the neuroimaging according to their ideological bias. They are saying brain abnormalities for these people are psychological. But this is unproven.