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The complex syndrome of functional neurological disorder, 2022, Edwards et al

Discussion in 'Other psychosomatic news and research' started by Sly Saint, Jan 7, 2022.

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  1. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    Abstract
    Background
    Patients with functional neurological disorders (FND) often present with multiple motor, sensory, psychological and cognitive symptoms. In order to explore the relationship between these common symptoms, we performed a detailed clinical assessment of motor, non-motor symptoms, health-related quality of life (HRQoL) and disability in a large cohort of patients with motor FND. To understand the clinical heterogeneity, cluster analysis was used to search for subgroups within the cohort.

    Methods
    One hundred fifty-two patients with a clinically established diagnosis of motor FND were assessed for motor symptom severity using the Simplified Functional Movement Disorder Rating Scale (S-FMDRS), the number of different motor phenotypes (i.e. tremor, dystonia, gait disorder, myoclonus, and weakness), gait severity and postural instability. All patients then evaluated each motor symptom type severity on a Likert scale and completed questionnaires for depression, anxiety, pain, fatigue, cognitive complaints and HRQoL.

    Results
    Significant correlations were found among the self-reported and all objective motor symptoms severity measures. All self-reported measures including HRQoL correlated strongly with each other. S-FMDRS weakly correlated with HRQoL. Hierarchical cluster analysis supplemented with gap statistics revealed a homogenous patient sample which could not be separated into subgroups.

    Conclusions
    We interpret the lack of evidence of clusters along with a high degree of correlation between all self-reported and objective measures of motor or non-motor symptoms and HRQoL within current neurobiological models as evidence to support a unified pathophysiology of ‘functional’ symptoms. Our results support the unification of functional and somatic syndromes in classification schemes and for future mechanistic and therapeutic research.

    https://www.cambridge.org/core/jour...cal-disorder/928FA00043CEA47612B9F0EACB2C4BB8
     
    Peter Trewhitt likes this.
  2. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    Alternatively, the lack of "clustering" could be due to the questionnaires themselves lacking in specificity.
     
    Ash, chrisb, Michelle and 12 others like this.
  3. Mithriel

    Mithriel Senior Member (Voting Rights)

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    A few things spring to mind. Motor FND may be all one disease or it could be that symptoms (including depression and anxiety) are very similar across all motor disabilities. They did not have a control group of MS patients or Parkinson patients with a similar level of disability.

    indicates that patients had a very good grasp of their actual limitations, they were not exaggerating and did not have any false perceptions.

    Another thing is they do not address that FND does not just include motor disorders. How do people with IBS or seizures or interstitial cystitis fit?

    So they take a subgroup with similar symptoms say they all have similar symptoms and use that to say ALL functional disorders are similar with the implication that it is correct to say it is a new name for hysteria.
     
    Amw66, Ash, Art Vandelay and 6 others like this.
  4. alktipping

    alktipping Senior Member (Voting Rights)

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    Another seven people who assume an unproven hypothesis is a n accepted fact . personally i would not allow them anywhere near patients .
     
    chrisb, Peter Trewhitt and Lou B Lou like this.
  5. Snowdrop

    Snowdrop Senior Member (Voting Rights)

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    What I am starting to find interesting is that I think I'm starting to see a new pattern in papers. Someone can enlighten me if they have better knowledge. It looks to me like the usual British writers of suspect papers are increasingly teaming up with researchers from outside UK. There was always some of that going on but they seem to be looking increasingly farther afield.

    I'm just hoping it means funding is being more carefully scrutinised as to it's benefit. Writing a new paper on the same subject with a huge archive with remarkably similar conclusions should never have been considered money well spent.
     
    alktipping, Ash, chrisb and 3 others like this.
  6. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    I'm glad I was never diagnosed with FND when I had serious gait problems. Luckily for me my real problem was discovered by accident as a result of having a CT scan for a possible stroke (I hadn't had a stroke.). It turned out I had NPH - Normal Pressure Hydrocephalus. Without the accident of the CT scan I would probably have remained either ignored or been diagnosed with a mental illness.
     
    Sean, alktipping, Mithriel and 4 others like this.

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