Medische literatuur en lezingen

“In my view, incongruence needs retirement. It should be sent to the FND section of the neuromythology graveyard where it can join ‘la belle indifférence’, ‘non-organic’ and the universal application of ‘conversion disorder’. Here is what I object to, and find incongruent, about this sign still being used in the clinical assessment of FND.”

Lezing in de serie FNS Kennissessies

Lezing in de serie FNS Kennissessies over neuroimaging.

“Multidisciplinary collaboration is needed to fill current knowledge gaps, with multispecialty teams helping to overcome the deficits in outcomes and prognosis still affecting FND, one of the commonest and most expensive neurological disorders currently affecting humankind.“

“They first outline a set of relevantworking principles of the brain, followed by a focused review of the theory of constructed emotion to introduce a new understanding ofwhat emotions are. Building on this theoretical framework, they formulate how altered emotion category construction can be an integral component of the pathophysiology of functional neurological disorder and related functional somatic symptoms.“

“Noncoding for FND is common. Most factors that amplify noncoding also hinder face-to-face communication. Research based on ICD-10 coding (eg, prevalence and cost) may underestimate the impact of FND by >fourfold.”

“Communication problems, swallowing disorders, cough and upper airway symptoms, resulting from FND, are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people.“

“FBS zijn veelvoorkomende en invaliderende neurologische ziektebeelden met een forse impact op het dagelijks functioneren van patiënten die eraan lijden. Gezien de complexe en multifactoriële aard is het vanzelfsprekend dat er een team van verschillende specialisten betrokken is bij de behandeling van FBS.“

“De afgelopen jaren zijn de inzichten omtrent de etiologie en pathofysiologie van FBS significant veranderd. (…) In dit artikel bespreken we de nieuwe ontwikkelingen op het gebied van de etiologie, pathofysiologie, diagnostiek en behandeling van FBS.”

“FND challenges the artificial divide between physical and mental health that is pervasive in healthcare and society. FND is a model disorder to understand complex brain-mind-body concepts in medical conditions.”

“In this paper, we systematically review the evidence for outpatient individual psychotherapy for adults with FND, with a focus on the evidence for PDT and CBT.”

“ This paper summarises two recent discussions hosted by the American Epilepsy Society and Functional Neurological Disorders Society on the naming of this condition. These discussions are conceptualised as the initial step of an exploration of whether it might be possible to build consensus for a new diagnostic label.“

“What if the patients most health professionals actively seek to avoid, people with ‘medically unexplained’ or functional symptoms, were those who hold the key to a more successful, more rewarding and more just system of medical practice for all? I think they do. They force us to answer the question, to paraphrase Wittgenstein: What is left over, if I subtract the fact that I have a disease, from the fact that I am ill?“

“MS and FND are both diagnostically challenging conditions which can present with similar symptoms. We systematically reviewed the literature to identify patients with MS who were misdiagnosed with FND, patients with FND who were misdiagnosed with MS, and reports of patients with both conditions.“

“In this review, we explore the challenges of chronic pain and fatigue in clinical practice. Both pain and fatigue are common, troubling and frequently overlapping symptoms, and we describe both the clinical burden and the ‘clinical problem’.”

“We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.“

“Medically unexplained symptoms or persistent physical symptoms are common, real and are associated with significant distress, loss of functioning and high healthcare costs. History, examination and appropriate investigations are essential to make a diagnosis. Once the diagnosis has been made, exploring the impact of the symptoms helps us to tailor our advice to patients. This paper sets out a practical approach to taking a history, assessment and stepwise management principles.“

“Normal baseline investigation results in a patient with common symptoms is often labelled as being due to a functional disorder, with all the pejorative connotations that go along with that term. When given the opportunity to see a patient for a second opinion, it is important to retain an open mind rather than assuming previous assessments are correct.”

“The aim of this study was to test a cognitive behavioural model of idiopathic drop attacks, in order to inform formulation and treatment. Interviews and diaries were completed by seven individuals experiencing drop attacks, and were analysed using a grounded theory qualitative data approach.”

“Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurology–psychiatry intersection. After being marginalised in the late 20th century, there has been renewed interest in this field. In this article, we review advances that have occurred over the past decade (2011–2020) across diagnosis, mechanisms, aetiologies, treatments and stigma in patients with motor FND (mFND, that is, functional movement disorder and functional limb weakness).“

“Neurological and neuropsychiatric adverse events have been reported in clinical trials of various SARS-CoV-2 vaccines and, more often, in open-label monitoring. In many cases, no definitive evidence has yet supported causality. Despite this, there are recognised rare adverse events that have been causally linked to SARS-CoV-2 vaccines, for example, VITT. The necessary ongoing surveillance work is in progress; however, the current advice that the benefit of the vaccination outweighs the risk appears to be accurate from a neurological standpoint.”

“Aim: 1) To explore the feasibility to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI). 2) To generate proof of concept regarding a possible role for cytokines, microRNA, cortisol levels and neurocognitive symptoms in patients with motor CD/FND.”

“The diagnosis of FND should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures. In treatment of FND, clear communication of the diagnosis and the involvement of the multidisciplinary team is beneficial. We recommend that patients with FND are referred to specialists with expertise in neurological diagnosis.”

“Individuals with FND exhibit corticolimbic abnormalities, yet little is known about the role of white matter tracts in the pathophysiology of FND. This study characterized between-group differences in microstructural integrity, and correlated fiber bundle integrity with symptom severity, physical disability and illness duration.”

“Patienten mit funktionellen neurologischen Störungen erleben in der Praxis oft, dass ihre Probleme nicht ernst genommen werden. Doch groß angelegte Studien und aktuelle neurowissenschaftliche Erkenntnisse lassen dieses vernachlässigte Teilgebiet der Neurologie in neuem Licht erscheinen.”

“Psychiatry training is lacking examples of neuroscience education that translates neuroscience literature into accessible clinically oriented concepts. The authors created a teaching activity using patient-centered neuroscience education that focused on delivering the diagnosis of FND. This study aimed to (i) develop a workshop modeling a clinician-patient interaction, (ii) provide a modern neuroscience perspective of FND, and (iii) evaluate the change in clinicians’ perceptions of FND.“

“Occupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.”

“The aim of this review is to discuss strategies for the management of FND by focusing on the diagnostic discussion and general principles, as well as specific treatment strategies for various FND symptoms, highlighting the role of the neurologist and proposing a structure for an interdisciplinary FND service.”

“Door de associatie met toneel- of showhypnose is het begrip ‘hypnose’ omgeven met veel misvattingen. Dit lijkt een breder gebruik in de geneeskunde in de weg te staan. En dat terwijl hypnose van oudsher wordt toegepast bij psychiatrische problemen, zoals posttraumatische stress, conversie en dissociatie-gerelateerde stoornissen.“

“The hyperacute clinical diagnosis of stroke remains a major challenge, as 1 in 4 suspected cases turns out to be a stroke mimic.”

“An increasing proportion of cognitive difficulties are recognized to have a functional cause, the chief clinical indicator of which is internal inconsistency. When these symptoms are impairing or distressing, and not better explained by other disorders, this can be conceptualized as a cognitive variant of functional neurological disorder, termed functional cognitive disorder (FCD).“

“In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases.“

“In this study we used a prospectively recruited, controlled cohort design to assess misdiagnosis, mortality and symptomatic and health outcome in patients with functional limb weakness compared to neurological disease and healthy control subjects. One hundred and seven patients with functional limb weakness, 46 neurological and 38 healthy control subjects from our previously studied prospective cohort were traced for follow-up after an average of 14 years.”

“Changing views of FND in the last 10 years mean that urological symptoms are once again being investigated as a potential part of functional disorders. Patients presenting with chronic idiopathic urinary retention, diagnosed as Fowler’s syndrome, or presenting with acute urinary retention and possible cauda equina syndrome, have been found to have high levels of functional disorder and FND comorbidity.”

“In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations.“

“Neuroimaging has provided new insights into functional movement disorders, supporting emerging neurobiological theories implicating dysfunctional emotional processing, self-image and sense of agency. Recent studies have also found subtle structural brain changes in patients with functional disorders, arguing against a strict functional/ structural dichotomy.”

Klinische les: Een patiënte met onverklaarde neurologische klachten

E.Maris, A. Ramdhani, A. Scholte
2019

Een case-study van een patiënte met diverse onverklaarde neurologische klachten.

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“Conclusions: The good accuracy to discriminate patients from controls suggests that RS FC could be used as a biomarker with high diagnostic value in future clinical practice to identify mFND patients at the individual level.“

Een case-study van een patiënte die tijdens haar bevalling een FNS-aanval krijgt.

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