“Stop fake!” Imagine hearing these words right after a doctor diagnoses something like a stroke or a brain tumor. It sounds silly, but for many people diagnosed with a condition called Functional Neuropathy (FND), this is exactly what happens.
Although this disorder is not well known to many, FND is actually one of the most common conditions neurologists like myself encounter. In it, abnormal brain function causes symptoms. There are many different forms of FND, with symptoms such as seizures, weakness, and movement disorders. People may lose consciousness or be unable to move or walk. Or you may experience unusual tremors or tics. It can be as disabling and costly as structural neurological conditions such as Lou Gehrig’s disease, multiple sclerosis, and amyotrophic lateral sclerosis (ALS), also known as Parkinson’s disease .
[Read more about new findings on functional neurological disorder]
Men can develop FND, but young to middle-aged women most often receive the diagnosis. FND also briefly made international headlines during her first two years of the COVID pandemic, when functional tic-like behavior became widespread through social media use, especially among adolescent girls. I was.
So why do doctors and other health care professionals blame people who have lost control of their limbs or who have had seizures that are faked? , have a poor or outdated understanding of FND, despite encountering it frequently. Because there’s nothing structurally wrong with your brain (e.g. no damage found in clinical trials), they may write your symptoms down as “all in your head” or dismiss them as psychological. I might. Recent studies show that the reaction can harm patients who are already suffering. Fortunately, there is another path, rooted in sensitivity, respect, and a new evidence-based approach.
Historically, FND was called “conversion disorder.” The term derives from the belief that traumatic stress was “transformed” into functional neurological symptoms via psychological mechanisms. This is no longer how we understand his FND.stress and trauma can play a role. In fact, some researchers believe that the unique global stressors our societies faced during the COVID pandemic made some people more susceptible to the condition. However, not all her FND patients have experienced traumatic events.
Instead, recent advances in brain imaging suggest that FND is caused by functional abnormalities in brain networks. Some experts use the analogy that the brain’s hardware (or structure) is unchanged, but the software (or processing) is malfunctioning. For example, studies show that in FND, neural networks (electrical and chemical signaling pathways between groups of neurons or larger brain regions) regulate traumatic stress, emotion regulation, sensorimotor function, attention processing, body recognition, and have been suggested to influence our responses to self-perception. Agencies are not working together as one would normally expect. These networks include limbic structures such as the amygdala, which are important for the brain’s processing of emotions and stress.
Neuroimaging highlights that people aren’t “faking” anything. bottom. There are also abnormal connections between brain regions responsible for interpreting internal body sensations and motor plans. Simply put, one of her hallmarks of FND is that patients perceive their symptoms as involuntary. In contrast, patients with the structural neurological condition Tourette syndrome reported some degree of control over tic inhibition, as investigated by researchers at the University of Calgary, Alberta, in a paper published last November. It has been.
Clinicians are also finding better ways to diagnose FND. Until now, neurologists considered conversion disorder a diagnosis of exclusion. Briefly, the diagnosis was made after ruling out structural neurological abnormalities through examination, radiographic imaging, laboratory studies, and neurophysiological tests such as electroencephalography (EEG). As a result, many of her FND patients felt that their doctors told them what they didn’t have, not what they had.
However, in the last decade neurologists have developed diagnostic criteria to determine which symptoms are associated with functional brain abnormalities. These highlight the characteristic ‘positive’ or ‘rule-in’ findings based on the neurologist’s physical examination that could predict her FND as the basis for the patient’s symptoms. A combination of thorough neurological examination, EEG, brain imaging, and clinical examination indicates whether a patient’s symptoms are consistent with a structural brain pathology (e.g., stroke or brain tumor) or a functional condition such as FND can do.
These advances in diagnosing and understanding FND mean that physicians are better positioned than ever to identify and understand this disease. Nevertheless, many patients still have the disorienting and painful experience of being dismissed or treated with distrust by medical professionals.
This reaction has detrimental consequences. In January, a collaborative study by researchers from the University of Sheffield, United Kingdom, Arizona State University, and the Northeast Regional Epilepsy Group found that clinicians’ unsupportive responses to patients were a shame to those already on treatment. Case studies and other evidence have been published that it may contribute to the feeling of suffer mentally from their functional symptoms. In fact, being shy itself may be an added risk factor for her FND.
This connection with shame and stigma becomes even more important given that minority groups, such as members of the LGBTQ+ community, may be at higher risk of dysfunction. Experiencing stressors such as discrimination, prejudice and stigma Individuals who do may internalize feelings of shame when their psychosocial support systems and coping mechanisms are inadequate or overwhelmed because of their marginalized identity. If someone in this situation has her FND, being treated by a doctor who lacks empathy or understanding of their current condition will only make matters worse. Telling patients that their condition is “in their heads” leads to medical misinformation and further stigmatizes patients with these disorders.
However, this problem can be solved. Researchers have found that how empathetically doctors communicate their FND diagnosis to their patients influences their likelihood of accepting the diagnosis and having successful treatment. . Treatment can combine psychoeducation, medication for coexisting mental health conditions, psychotherapy, and physical therapy. The results for people who receive meticulous and proper care are actually very good.
This year my colleagues and I will present our observations on the treatment of LGBTQ+ people with FND. Our preliminary findings are promising. Most patients showed improvement or complete resolution of functional symptoms after treatment. These results may be very important in some patients. We treated a patient with functional blindness and restored his vision. I have also seen people in wheelchairs become able to walk. In short, care and compassion can be powerful medicine.
Are you a scientist specializing in neuroscience, cognitive science, or psychology, and have you read a recent peer-reviewed paper you’d like to contribute to Mind Matters? Send your suggestions to Scientific Americanby Mind Matters Editor Daisy Juhas pitchmindmatters@gmail.com.
This is an opinion and analysis article and views expressed by the author or authors are not necessarily Scientific American.
