The vicious cycle of functional neurological disorders: a synthesis of healthcare professionals’ views on working with patients with functional neurological disorder

2020 ◽  
pp. 1-10
Author(s):  
Caroline Barnett ◽  
Rebecca Davis ◽  
Claire Mitchell ◽  
Sarah Tyson
Keyword(s):  
Neurological Disorders ◽  
Neurological Disorder ◽  
Healthcare Professionals ◽  
Vicious Cycle ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

scholarly journals Functional neurological disorders in patients with brain tumours

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv12-iv12
Author(s):  
Charmaine Toh ◽  
Dorothy Joe ◽  
Katia Cikurel ◽  
Julia Johnson ◽  
Francesco Vergani ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Brain Tumours ◽  
Neurological Symptoms ◽  
Adult Brain ◽  
Case Review ◽  
Functional Neurological Symptoms ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Abstract Aims Signs and symptoms that develop in people with brain tumours are often attributed to their tumour. The prevalence and management of functional neurological symptoms in brain tumour patients have received little attention. This is surprising because functional neurological symptoms complicate management greatly and misdiagnosis can lead to inappropriate treatment and iatrogenic side-effects. Therefore, we investigated the presentation, diagnosis and management of functional neurological disorders (FND) in patients who had a brain or meningeal tumour. Method A retrospective case review was performed from 2017 - 2021 to identify adult brain tumour patients who developed a functional neurological disorder that caused significant disability necessitating expedited investigations. All patients attended a regional neuro-oncology centre. We recorded type of brain tumour and diagnostic investigations. The onset of functional symptoms was divided into three time windows: before tumour diagnosis, after diagnosis and before treatment or after tumour treatment. A neuropsychological review looked for evidence of previous adverse life events. Therapeutic interventions for functional neurological disorder and their outcomes were documented. The case review was combined with a systematic review of the literature to identify the published presentations of functional neurological disorder in the adult brain tumour population. MEDLINE, EMBASE and PsycINFO databases were searched for studies published between January 1980 and February 2021. Results Six patients (5 female, 1 male) were identified from the case review with a median age of 41 (range 29 - 56) years old. Four patients had non-epileptic attack disorder, which was diagnosed with videotelemetry of habitual attacks. One patient had a functional hemiparesis with normal central motor conduction time. One patient had a functional speech disorder with normal EEG. Half of these patients had functional neurological symptoms prior to surgery/oncological treatment. Five patients (83%) were referred for further neuropsychiatric or psychological evaluation. A history of significant psychological trauma prior to the brain tumour diagnosis was elicited in four (66%) patients. Conclusion Patients with either a brain or meningeal tumour may develop functional neurological symptoms. Our findings suggest the possibility that diagnosis of a brain tumour may precipitate a debilitating functional neurological disorder. The neurobiological basis for functional neurological disorders is being actively investigated. There are suggestions in the literature that some brain diseases increase the risk of developing a functional neurological disorder. Further work is needed to determine whether this is true for patients with brain tumours. Increased awareness of functional neurological disorders will improve management. Withdrawal of unnecessary treatment, such as anticonvulsant drugs, reduces the risk of iatrogenic side effects. Initiation of multi-disciplinary care pathways, e.g. physiotherapy, speech and language therapy and psychological treatments, promotes recovery. Collectively, these interventions improve our patients’ quality of life.

scholarly journals The Arc de Siècle: functional neurological disorder during the ‘forgotten’ years of the 20th century

Brain ◽  
2020 ◽  
Vol 143 (4) ◽  
pp. 1278-1284
Author(s):  
Max Fend ◽  
Louise Williams ◽  
Alan J Carson ◽  
Jon Stone
Keyword(s):  
20Th Century ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Oral Histories ◽  
Pragmatic Approach ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Using archived records, plus oral histories from retired neurologists, Fend et al. examine attitudes to functional neurological disorders in the mid-20th century. While frequently scathing in their correspondence, most neurologists of the time adopted a pragmatic approach with many referring patients to psychiatrists.

The challenge of functional neurological disorder – views of patients, doctors and medical students

2021 ◽  
Vol 16 (2) ◽  
pp. 123-138
Author(s):  
Gareth Hutchinson ◽  
Stefanie Caroline Linden
Keyword(s):  
Medical Students ◽  
Therapeutic Relationship ◽  
Neurological Disorder ◽  
Treatment Options ◽  
Patient Survey ◽  
Structured Interviews ◽  
Content Type ◽  
Doctor Patient Communication ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Purpose This study aims to explore views and attitudes of doctors, patients and medical students in regard to Functional Neurological Disorders (FND), a common presentation in neurological and psychiatric practice. Design/methodology/approach We conducted semi-structured interviews with 11 clinicians and obtained online questionnaires from 21 patients and 75 medical students. We applied thematic analysis. Findings The clinician and patient surveys highlighted the importance of the therapeutic relationship and need for transparent communication. However, patients criticised excessive reliance on online resources in doctor–patient communication. They also emphasised the relevance of triggering life events, which was not a prominent theme for clinicians. Medical students had only scant knowledge of the concept of functional neurological disorder. Practical implications A good therapeutic relationship is considered central for outcome of FND by both clinicians and patients. The survey of medical students has identified considerable gaps in undergraduate medical education in FND. The patient survey can inform recommendations for the explanation of aetiological models and treatment options in clinical practice. Originality/value This is the first study exploring the attitudes of clinicians, medical students and patients to FND. The study highlights potential areas of disagreement between these groups.

scholarly journals Revising a diagnosis of functional neurological disorder—a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Alex J Berry ◽  
Sarah Wiethoff
Keyword(s):  
Case Report ◽  
Functional Impairment ◽  
Symptom Onset ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Neurodegenerative Disorder ◽  
Evidence Base ◽  
Clinical Progression ◽  
Degree Of Confidence ◽  
Functional Neurological Disorder

ABSTRACT We report a case of a 62-year-old female diagnosed with functional neurological disorder (FND), where the diagnosis was eventually revised to progressive supranuclear palsy 3 years after symptom onset. FND is a commonly encountered condition and can be diagnosed with a considerable degree of confidence in most cases. FND is associated with significant functional impairment and may occur alongside other neurological disorders, and there is now a growing evidence base for symptom-specific FND treatments. Charting clinical progression of symptoms and serial neuroimaging were useful in refining the diagnosis in this case. Alhough the diagnosis was ultimately revised to a neurodegenerative disorder, a degree of functional overlay likely remained present. The case highlights the importance of recognizing and avoiding diagnostic overshadowing in those with FND.

scholarly journals Functional Neurological Disorders as Seen by a Cohort of General Practitioners in Northern Italy: Evidence From an Online Survey

2021 ◽  
Vol 12 ◽  
Author(s):  
Angela Marotta ◽  
Mirta Fiorio ◽  
Isabella Fracasso ◽  
Carlo Andrea Franchini ◽  
Giovanni Defazio ◽  
...  
Keyword(s):  
General Practitioners ◽  
Professional Education ◽  
Neurological Disorders ◽  
Online Survey ◽  
Northern Italy ◽  
Web Based ◽  
Novel Approaches ◽  
Psychological View ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

General practitioners (GPs) provide primary care and advise their patients on which diagnostic and therapeutic pathways they judge most appropriate. For patients with functional neurological disorders (FND), receiving a proper explanation of diagnosis by their GP from the very beginning may drastically improve prognosis. Novel approaches to the diagnosis and treatment of FND have important implications for effective management. The aim of this study was to investigate Italian GP opinion and knowledge about FND in light of new approaches to the illness. To do this, we evaluated the responses to a 13-item web-based survey completed by 133 GPs practicing in northern Italy. Psychological terms to describe FND were more frequently used than functional neurological disorder and mental illness was considered an important predictor of diagnosis. Referral to a neurologist rather than to a psychiatrist was largely preferred, while physiotherapy consultation was seldom recognized as a valuable approach to treating FND. Overall, the survey findings suggest that knowledge about novel approaches to FND is somewhat lacking. Currently, GPs appear to be transitioning from a classical psychological view of the disorder toward a more modern conceptualization, in which neurobiological, psychological, and social factors all play an important role. Professional education during this transition would be an advantageous way to optimize physician management of FND and to enhance diagnosis, explanation, and management across primary and secondary care pathways.

scholarly journals ‘Cryptogenic Drop Attacks’ revisited: evidence of overlap with functional neurological disorder

2018 ◽  
Vol 89 (7) ◽  
pp. 769-776 ◽  
Author(s):  
Ingrid Hoeritzauer ◽  
Alan J Carson ◽  
Jon Stone
Keyword(s):  
Neurological Disorders ◽  
Limb Weakness ◽  
Drop Attacks ◽  
Dissociative Symptoms ◽  
Persistent Fatigue ◽  
Predominantly Female ◽  
Functional Limb ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

ObjectiveIn their 1973 BMJ paper ‘Cryptogenic Drop Attacks’, Stevens and Matthews described 40, mostly middle-aged, female patients with drop attacks of unknown cause. Although clinically common, there has been little on this topic since. We aimed to determine clinical features, comorbidity and outcome of patients with drop attacks.MethodsWe carried out a retrospective review of patients with cryptogenic drop attacks seen consecutively by one clinician (JS) between 2006 and 2016. Demographics, phenomenology, duration and frequency of attacks, attack description and comorbid diagnoses were recorded. Patients were followed up with a notes review.Results83 patients with cryptogenic drop attacks were predominantly female (89%, n=79), mean age 44  years. The majority (93%, n=77) could not remember the fall itself and almost half (43%, n=36) experienced prodromal dissociative symptoms. Mechanical trips or syncope preceded drop attacks, historically, in 24% (n=20) of cases. Persistent fatigue (73%, n=61), chronic pain (40%, n=33), functional limb weakness (31%,n=26) and dissociative (non-epileptic) attacks 28% (n=23) were common, with the latter usually preceding or emerging from drop attacks. At follow-up (88%, mean 38 months), 28% (n=23) had resolution of their drop attacks. Predisposing (but non-causative) disease comorbidity was found at baseline (n=12) and follow-up (n=5).ConclusionsCryptogenic drop attacks are associated with high frequency of comorbid functional somatic and functional neurological disorders. Patients commonly have prodromal dissociative symptoms and in some there was a clear relationship with prior or subsequent dissociative (non-epileptic) attacks. Some cryptogenic drop attacks may be best understood as phenomena on the spectrum of dissociative attacks.

The relationship between psychosocial trauma type and conversion (functional neurological) disorder symptoms: a cross-sectional study

2021 ◽  
pp. 103985622110092
Author(s):  
Shimaa K. Morsy ◽  
Daniela Huepe-Artigas ◽  
Ahmed M. Kamal ◽  
Maha Ali Hassan ◽  
Nashaat Adel Abdel-Fadeel ◽  
...  
Keyword(s):  
Neurological Disorder ◽  
Conversion Disorder ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Trauma Symptom ◽  
Functional Symptoms ◽  
Neurology Clinic ◽  
The Relationship ◽  
Trauma Type ◽  
Functional Neurological Disorder

Objective: Psychosocial trauma was associated with developing conversion disorder (also known as functional neurological disorder) before Freud, though why a particular symptom should arise is unknown. We aimed to determine if there was a relationship between trauma type and symptom. Methods: We retrospectively reviewed the medical records of patients attending Australia’s first functional neurology clinic, including referral, clinic letters and a clinic questionnaire. Results: There were 106 females, 43 males and five transgender patients. Sensory (51%), motor (47%) and seizures (39%) were the commonest functional symptoms. Most patients (92%) reported stressors associated with symptom onset. Multiple trauma/symptom type associations were found: patients with in-law problems experienced more cognitive symptoms ( p = .036), for example, while expressive speech problems more commonly followed relationship difficulties ( p = .021). Conclusion: Associations were found between type of traumatic events and type of symptoms in conversion disorder. This will require verification in a larger sample.

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