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.

From emotion processing to metacognition: mnemonic contributions in conversion/functional neurological symptoms

2018 ◽  
Author(s):  
Indrit Bègue
Keyword(s):  
Brain Lesion ◽  
Conversion Disorder ◽  
Neurological Symptoms ◽  
Neural Systems ◽  
Past Century ◽  
Self Monitoring ◽  
The Past ◽  
Functional Symptoms ◽  
Functional Neurological Symptoms ◽  
Functional Neurological Disorder

Functional neurological disorder (FND) is the term used (DSM-5) to refer to a disabling neuropsychiatric condition that is frequently encountered in medical practice, previously known as conversion disorder (CD) and described as Hysteria in the past century. It is characterised by neurological symptoms (e.g., weakness, numbness, tremor…) without evidence for any brain lesion. Early neurobiological accounts of this disorder were part of the foundation of psychiatry and neurology, but were then dominated by a purely psychodynamic perspective. The advent of neuroimaging in the last two decades has allowed a renewed interest in the “functional” brain underpinnings of these symptoms, with growing interest and increasing attempts to investigate them in a neuroscience perspective. In this brief review, I discuss recent evidence pointing to how top-down mechanisms may alter motor function in patients with motor FND/CD, through coupling with neural systems associated with internal self-monitoring, emotion regulation, and memory, and thus lead to the emergence of functional symptoms. More research however still needs to be undertaken to elucidate the causes (why they occur) of FND/CD, in addition to their neuro-anatomical substrates (how they occur).

scholarly journals A Position Statement on the Utility of Interval Imaging in Standard of Care Brain Tumour Management: Defining the Evidence Gap and Opportunities for Future Research

2021 ◽  
Vol 11 ◽  
Author(s):  
Thomas C. Booth ◽  
Gerard Thompson ◽  
Helen Bulbeck ◽  
Florien Boele ◽  
Craig Buckley ◽  
...  
Keyword(s):  
Health Economics ◽  
Brain Tumour ◽  
Study Design ◽  
Brain Tumours ◽  
Data Science ◽  
Standard Of Care ◽  
Structural Mri ◽  
Adult Brain ◽  
Current Evidence ◽  
Imaging Biomarkers

Objectiv eTo summarise current evidence for the utility of interval imaging in monitoring disease in adult brain tumours, and to develop a position for future evidence gathering while incorporating the application of data science and health economics.MethodsExperts in ‘interval imaging’ (imaging at pre-planned time-points to assess tumour status); data science; health economics, trial management of adult brain tumours, and patient representatives convened in London, UK. The current evidence on the use of interval imaging for monitoring brain tumours was reviewed. To improve the evidence that interval imaging has a role in disease management, we discussed specific themes of data science, health economics, statistical considerations, patient and carer perspectives, and multi-centre study design. Suggestions for future studies aimed at filling knowledge gaps were discussed.ResultsMeningioma and glioma were identified as priorities for interval imaging utility analysis. The “monitoring biomarkers” most commonly used in adult brain tumour patients were standard structural MRI features. Interval imaging was commonly scheduled to provide reported imaging prior to planned, regular clinic visits. There is limited evidence relating interval imaging in the absence of clinical deterioration to management change that alters morbidity, mortality, quality of life, or resource use. Progression-free survival is confounded as an outcome measure when using structural MRI in glioma. Uncertainty from imaging causes distress for some patients and their caregivers, while for others it provides an important indicator of disease activity. Any study design that changes imaging regimens should consider the potential for influencing current or planned therapeutic trials, ensure that opportunity costs are measured, and capture indirect benefits and added value.ConclusionEvidence for the value, and therefore utility, of regular interval imaging is currently lacking. Ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.

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.

Paediatric brain tumours

2019 ◽  
pp. 1009-1022
Author(s):  
Jonathan Roth ◽  
Shlomi Constantini
Keyword(s):  
Brain Tumour ◽  
Blood Volume ◽  
Brain Tumours ◽  
Genetic Factors ◽  
Adult Population ◽  
Adult Brain ◽  
Related Factors ◽  
The Subject ◽  
Surgical Aspects ◽  
Paediatric Brain Tumours

Paediatric brain tumours (PBT) are a unique entity, in children and in the overall general brain tumour population. They are distinct from adult brain tumours for several reasons, including patient-related factors (size, blood volume), location of the tumours, histological and genetic factors, treatment factors, and prognosis. Even technical surgical aspects may differ from those applied in the adult population. This chapter reviews the main aspects of PBT and their treatment in relation to the aforementioned factors. This text has pinpointed the most important topics of PBT but due to the breadth of the subject, this text cannot be a comprehensive account of every aspect of these pathologies or their treatments.

scholarly journals Conversion disorder and/or functional neurological disorder: How neurological explanations affect ideas of self, agency, and accountability

2020 ◽  
Vol 33 (5) ◽  
pp. 64-84
Author(s):  
Jonna Brenninkmeijer
Keyword(s):  
Neurological Disorder ◽  
English Language ◽  
Conversion Disorder ◽  
The Body ◽  
Neurological Symptoms ◽  
Self Control ◽  
Patient Reports ◽  
Long Time ◽  
Medically Unexplained ◽  
Functional Neurological Disorder

An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder (CD) and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events can be converted into deviant behaviour – these neurologists use the term functional neurological disorder (FND) and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability.

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