News article - The crippling brain condition doctors say is all in your mind

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Sbag

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Daily Mail article about a girl - “ diagnosed with functional neurological disorder, or FND. It affects the central nervous system – and, for decades, has been dismissed by doctors as being ‘all in the mind’. And that leaves FND patients’ fighting to be taken seriously, in a similar way to those with chronic fatigue syndrome, or ME.

This is also thought to be a fault with the central nervous system, and affects 250,000 Britons. ME causes physical and mental fatigue as well as painful limbs, loss of concentration and digestive issues.

Distressingly, as no physical cause can be found, ME was commonly misdiagnosed, often as depression, stress or another mental health problem, as symptoms can seem similar.

Now, leading experts have dubbed FND ‘the new ME’ and warn that, for similar reasons, thousands of Britons may not be receiving appropriate treatment.”

https://www.dailymail.co.uk/health/...ft-18-kayaking-world-champion-wheelchair.html
 
Sbag said:
Now, leading experts have dubbed FND ‘the new ME’ and warn that, for similar reasons, thousands of Britons may not be receiving appropriate treatment.”
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Some predicted that functional neurological disorder would be promoted as replacement for ME.

Presumably they would stop diagnosing ME and instead prefer to give a FND diagnosis, so that patients can continue to be given CBT. Until the FND patients revolt much in the same way we did.
 
strategist said:
Some predicted that functional neurological disorder would be promoted as replacement for ME.

Presumably they would stop diagnosing ME and instead prefer to give a FND diagnosis, so that patients can continue to be given CBT. Until the FND patients revolt much in the same way we did.
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Already being done - a few FND with CF being diagnosed in Lothian ( the land of John Stone)
 
Just some cherry-picking from the Stone/ Sharpe/ Carson paper (2005):

Collapsing weakness
'[...] These concerns have been vindicated in the small number of validity studies of this sign which have found that it is a rather poor discriminator between functional and disease related symptoms.
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midline splitting
Studies of both midline splitting and splitting of vibration sense have found they are common in patients with disease and so cannot be recommended
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Movement disorder
The diagnosis of a functional movement disorder is particularly challenging because of the unusual nature of some organic movement disorders. This is illustrated in the disproportionate number of movement disorders in cases where structural disease has been misdiagnosed as functional. [bolding mine]
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It must be remembered that all movement disorders vary to some degree and will get worse during times of stress or worry, so minor variability is not helpful.
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Improvement with distraction [...] Again, organic movement disorders may be susceptible to these factors to a degree.
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Dizziness
Anxiety and phobic avoidance of situations or head positions that bring on dizziness does not necessarily indicate a “psychogenic” aetiology. [Bolding mine, quotation marks in the original.]

On the other hand, such phobic avoidance may continue after the initial pathology has resolved.
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Asking the patient to hyperventilate to see if that reproduces the symptoms might appear straightforward, but it has a high false positive rate in patients with dizziness cause by disease.
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A full assessment of vestibular abnormalities, provoking stimuli and emotional symptoms can lead to tailored treatment in the form of vestibular rehabilitation and/or a cognitive behavioural approach regardless of the aetiology.
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Speech and swallowing symptoms
Be careful though, as these types of speech disturbance can also be seen in patients with disease.
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The possibility of spasmodic adductor or abductor dysphonia must always be considered.
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Visual symptoms
Monocular diplopia or polyopia may be functional but can be caused by ocular pathology.
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Investigations
Preferably investigations should be performed as quickly as possible, as protracted testing maintains a focus on looking for disease rather than on rehabilitation. The need to look for disease also needs to be balanced against the risk of uncovering laboratory or radiological abnormalities that have nothing to do with the symptoms but which may delay or disrupt positive management.

If tests are abnormal and relevant then positive functional signs should not necessarily be ignored. It may be necessary to make two diagnoses—one of an organic disease such as multiple sclerosis and another of additional functional weakness or disability.
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CONCLUSIONS: ASSESSMENT AND DIAGNOSIS
Functional symptoms are one of the most common reasons for consulting a neurologist. The assessment of such patients can be made more efficient and interesting by adapting the history, obtaining all the symptoms early on, asking about illness beliefs, and being careful about how and when you ask about psychological symptoms. In making the diagnosis the presence of positive functional signs are of key importance but should be used cautiously. Finally, be prepared to make a diagnosis of additional functional disability in someone with a known organic disorder. [bolding mine]
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edited to add: see also https://www.s4me.info/threads/myste...-health-new-scientist.8932/page-2#post-160325

https://www.s4me.info/threads/myste...-health-new-scientist.8932/page-2#post-160380

https://www.s4me.info/threads/chara...2019-oconnell-wessely-et-al.8270/#post-145802
 
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There clearly is a push to eventually reclassify everything they can't understand as FND. The underlying belief being that there is only one functional disorder but with different manifestations which gives rise to myriad diagnoses.
 
Stone probably moved away from some of the stances displayed in the, in my opinion, very muddled paper from 2005 co-authered with Sharpe.

Among more recent publications, his sadly unsuccessful effort to have FND categorized in the ICD neurology chapter and not as a dissociative disorder (if I undestood this properly), might indicate such an altered stance. In any case, I think these efforts are to be appreciated.

But to me, Stone still seems to be not clear about what he is saying and meaning. So at least one continuity appears to be his muddled writing.

Another point is, that neurological diseases or head injuries can be (and I think often are to a higher percentage than non-neurological diseases[?]) accompanied by emotional and mental issues and if needed, patients should openly be offered assessment and treatment for these issues, too.
 
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Re. the slide above. I have wondered before how many instances of malingering are the result of a dysfunctional healthcare-system/patient relationship where the patient is not taken seriously and tries to be taken more seriously by exaggerating their problems.
 
We still have two threads on this but not sure if they should be merged.

MSEsperanza said:
Stone probably moved away from some of the stances displayed in the, in my opinion, very muddled paper from 2005 co-authered with Sharpe.... I think these efforts are to be appreciated.

But to me, Stone still seems to be not clear about what he is saying and meaning.
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I agree. I think Stone's approach to diagnosis may be very fair. FND is a very real problem and it makes sense to talk of it as a software rather than a hardware problem. Even software involves physical changes - but in both computers and brains it probably involves abnormal patterns of normal types of microscopic change in information storing structures. (The same thing applies to autoantibody formation in a sense.)

Where Stone still seems muddled is in the treatment he is recommending (I think) and maybe in putting things across to journalists as if the same old 'mind interacting with body' story were involved.
 
MeSci said:
https://www.neurosymptoms.org/not-imagined/4594358022

"You don’t have a disease..."
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... but an illness:
"Seeing how it fits in with all your other symptoms can also be an important part of understanding it. It can help to understand that your weakness is one symptom among many (usually pain, fatigue and sleep disturbance) and that you have one illness with many symptoms, not many symptoms caused by different diseases.

For this reason, it is probably the case that some of the treatments that are proven to be effective for patients with chronic fatigue syndrome/ME and chronic pain are also helpful for patients with functional weakness.

These include

1. Graded exercise / physiotherapy

2. Cognitive behavioural therapy

3. Medication to help pain and sleep"
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https://www.neurosymptoms.org/limb-weakness/4594358036

There seems to be a difference between disease and illness?

(I have to admit that I don't understand the difference. The German language has the terms "Krankheit" and "Erkrankung", but I'm not sure if they mean different things.)
 
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