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.

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.

scholarly journals Modification of both functional neurological symptoms and neuroimaging patterns with a good anatomoclinical concordance: a case report

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Silvio Galli ◽  
Selma Aybek ◽  
Sylvie Chokron ◽  
Thierry Moulin ◽  
Eloi Magnin
Keyword(s):  
Neurological Disorder ◽  
Parietal Lobe ◽  
Single Photon ◽  
Photon Emission ◽  
Conversion Disorder ◽  
Emission Computed Tomography ◽  
Sensorimotor Deficit ◽  
Neural Underpinnings ◽  
The Right ◽  
Functional Neurological Disorder

Abstract Background In the nineteenth century, Jean Martin Charcot explained functional neurological disorder (formerly called conversion disorder) as a “psychodynamic” lesion. Numerous advances in neuroimaging have permitted identification of the neural underpinnings of this disorder. Case presentation Herein we describe a case of functional neurological disorder (FND) with initial left sensorimotor deficit, in-coordinated limb movements, neglect, clouded consciousness, slurred speech and a semiology of visual impairment. A single photon emission computed tomography (SPECT) showed a right thalamic hypoperfusion, which is rather concordant with the initial semiology. Later, the semiology changed, presenting with a predominantly neurovisual complex presentation. The second SPECT showed no more thalamic abnormalities but an hypoperfusion in the right temporo-occipital junction, right inferior parietal lobe and left superior frontal lobe, which is also rather concordant with the changing semiology. Conclusions This case illustrates the evolving neuroimaging patterns of FND but also the concordance between semiology and neuroimaging findings in FND supporting Charcot's theory of “dynamic lesion”.

24 An analysis of sentiment and publicity of functional neurological disorder and non-epileptic attack disorder on twitter

2020 ◽  
Vol 91 (8) ◽  
pp. e17.3-e18
Author(s):  
Felix May ◽  
Rohan Kandasamy
Keyword(s):  
Health Professionals ◽  
Neurological Disorder ◽  
Public Discourse ◽  
Medically Unexplained Symptoms ◽  
Awareness Campaigns ◽  
Search Terms ◽  
Epileptic Attack ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Functional Neurological Disorder

ObjectivesTwitter may provide a platform for clinicians and allied health professionals to publicise Functional Neurological Disorder (FND) and Non-Epileptic Attack Disorder (NEAD), and also provides a platform for patients and their communities to discuss the disorders. The prevalence and sentiment of discussions of these disorders have not been reported before now. We wrote a program to collect and analyse ‘Tweets’ about the subjects in their sentiment, connectivity and content.MethodsPreliminary searches and graph analyses identified the most relevant search terms. Tweets were collected automatically, along with available metadata. Sentiment analysis was performed using natural language processing with valence aware dictionary analysis, allowing automatic interpretation of text including idioms and ‘emojis’.Results13347 tweets were collected, with tweets not in English having been excluded from the analysis. The analysis showed a majority positive sentiment in the tweets. The most negative discourse was related to search terms: ‘Medically Unexplained Symptoms’ and ‘Psychosomatic’. Engagement with charities and tweets aiming to promote awareness of the disorders in question were common. Most frequent links to posts about FND were synonyms for the disorder, along with NEAD and charities and awareness movements. For NEAD, the most common links made were with FND, awareness campaigns, synonyms for NEAD, and Chronic Fatigue Syndrome.ConclusionsFND and NEAD have active communities on Twitter. These include both health professionals, patients and lay advocates. The overall sentiment is positive (p<0.05), but with some negativity from sceptical patients and some who are disappointed with their care, and with more negativity associated with certain search terms. (For example, more negative sentiment in tweets about ‘Medically Unexplained Symptoms’ compared to ones about ‘Functional Neurological Disorder’, p<0.0005). Public discourse analysis on websites such as Twitter may prove fruitful for monitoring patient understanding, trends in patient acceptance of diagnosis and factors contributing to these.

scholarly journals Neurocognitive functioning in patients with conversion disorder/functional neurological disorder

2020 ◽  
Author(s):  
Lars Vroege ◽  
Iris Koppenol ◽  
Willem Johan Kop ◽  
Madelon M.E. Riem ◽  
Christina Maria Feltz‐Cornelis
Keyword(s):  
Neurological Disorder ◽  
Conversion Disorder ◽  
Neurocognitive Functioning ◽  
Functional Neurological Disorder

scholarly journals Psychedelic treatment of functional neurological disorder: a systematic review

2020 ◽  
Vol 10 ◽  
pp. 204512532091212 ◽  
Author(s):  
Matthew Butler ◽  
Mathieu Seynaeve ◽  
Timothy R. Nicholson ◽  
Susannah Pick ◽  
Richard A. Kanaan ◽  
...  
Keyword(s):  
Neurological Disorder ◽  
Neural Circuits ◽  
Therapeutic Potential ◽  
Conversion Disorder ◽  
Evidence Base ◽  
Control Groups ◽  
Recent Interest ◽  
Psychedelic Drugs ◽  
Neuropsychiatric Conditions ◽  
Functional Neurological Disorder

Functional neurological disorder (FND), formerly known as conversion disorder, causes a high burden of disability and distress, and is amongst the most commonly encountered conditions in neurology clinics and neuropsychiatric services, yet the therapeutic evidence base is somewhat limited. There has been recent interest in the therapeutic potential of psychedelics such as psilocybin and lysergic acid diethylamide (LSD), and in recent studies psychedelics have shown promise in treating a range of neuropsychiatric conditions. Modification of neural circuits associated with self-representation is thought to underlie some of this effect, and as some contemporary theories of FND focus on aberrant somatic self-representation, psychedelics may therefore represent an unexplored treatment option for FND. We systematically reviewed studies involving the use of psychedelics in FND. Nine studies published between 1954 and 1967, with a total of 26 patients, were identified. Due to restriction of licencing of psychedelic drugs since this period, no modern studies were identified. In most cases, patients received a course of psychotherapy with variable adjunctive administration of psychedelics (in a combination known as ‘psycholytic therapy’), with protocols varying between studies. Of those treated, 69% ( n = 18) were found to have made at least some recovery on heterogeneous and subjective clinician-rated criteria. Adverse events were mostly mild and transient; however, at least one patient terminated the study due to distressing effects. All included studies were of low quality, often lacking control groups and valid outcome measures. Although no conclusions on efficacy may be drawn from these data, further research may help to determine whether psychedelics offer a feasible, safe and effective treatment for FND.

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.

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