Dr. Vanessa Veloso and Dr. Jeremy Moeller discuss the complexities of Functional Neurological Disorders (FND), challenges in diagnosis, distinguishing PNEA from seizures, biomarkers for seizures, diagnosing functional movement disorders, and the importance of collaboration with mental health professionals in treating FND.
Functional neurological disorders have a subconscious origin induced by emotional distress, requiring a positive diagnostic approach.
Diagnosing these disorders involves identifying specific typical findings to confirm the diagnosis, emphasizing positive indicative signs over exclusionary methods.
Deep dives
Understanding Functional Neurological Disorders and Their Complexity
Functional neurological disorders, also known as conversion disorder or dissociative neurological symptom disorder, present a broad spectrum of disorders affecting individuals' ability to function without a complete understanding of the underlying mechanisms causing them. These disorders often manifest as physical symptoms induced by emotional distress, highlighting the subconscious nature of these phenomena. It is crucial to affirm the reality of functional illness and frame it positively to advance in diagnosis, understanding, and treatment, aiming to enhance patient care and treatment outcomes.
Diagnostic Challenges and Approaches for Functional Neurological Disorders
Diagnosing functional neurological disorders have transitioned from being an exclusionary process to identifying specific typical findings to confirm the diagnosis. Utilizing clues like internal inconsistency in symptoms, incompatibility with recognized diseases, aids in distinguishing functional disorders. The emphasis is on ruling in the diagnosis based on positive indicative findings, rather than exclusion. However, caution is necessary not to solely rely on single signs which can be shared among various disorders, necessitating a holistic evaluation and thoughtful consideration.
Mistaken Diagnoses and the Importance of Differential Diagnosis
Amidst the diagnostic challenges lie the risks of misdiagnosing functional disorders, especially in populations facing medical system challenges, mental health issues, or substance use disorders. Keeping an open mind and considering diverse differential diagnoses based on comprehensive evaluations is crucial to avoid missing organic conditions masked by functional presentations. While functional disorders require thorough testing for confident diagnoses, flexibility and continuous evaluation are key to ensuring accurate and timely diagnoses.
Treatment Strategies and Prognosis for Functional Neurological Disorders
Treatment approaches for functional neurological disorders vary based on the type and severity of the disorder, often necessitating a multidisciplinary effort involving neurologists and mental health professionals. Cognitive behavioral therapy, addressing underlying psychiatric conditions, or rehabilitative approaches like physical therapy may be beneficial. However, early diagnosis, effective communication, and regular follow-up are vital in improving patient outcomes, given the challenging prognosis and complex nature of these disorders.
A brief overview of the neurologist's role in the diagnosis and treatment of functional neurological disorders, with Drs. Vanessa Veloso and Jeremy Moeller.
Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.
Further Reading Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022 Jun;21(6):537-550. doi: 10.1016/S1474-4422(21)00422-1.
Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, Sharpe M. Systematic review of misdiagnosis of conversion symptoms and "hysteria". BMJ. 2005 Oct 29;331(7523):989. doi: 10.1136/bmj.38628.466898.55.
Stone J, Carson A, Duncan R, Coleman R, Roberts R, Warlow C, Hibberd C, Murray G, Cull R, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker J, Macmahon AD, Sharpe M. Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain. 2009 Oct;132(Pt 10):2878-88. doi: 10.1093/brain/awp220.
Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes. Epilepsy Behav. 2018 Dec;89:70-78. doi: 10.1016/j.yebeh.2018.10.010.
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