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Barbey, Anita, Irena Pjanic, Helene Studer, Nina Bischoff, Claudio L. A. Bassetti, and Selma Aybek. "Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic." Clinical and Translational Neuroscience 6, no. 1 (January 19, 2022): 2. http://dx.doi.org/10.3390/ctn6010002.
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Functional neurological disorder (FND) represent a common disorder with significant socio-economic impact. In this context and alongside recent new neuroscientific insights, FND attracts a growing interest both in clinical practice and academic activities. New international recommendation and expert opinions suggest that therapy of FND should be a tailored multidisciplinary management involving the neurologist, the physiotherapist, and in most cases the psychotherapist/psychiatrist. A first decisive step is the establishment of a definitive diagnosis, based on the presence of clinical positive signs during neurological assessment together with a clear communication and explanation of the diagnosis by the neurologist. A second important step is based on individual therapeutic sessions, involving different disciplines (neurology and psychotherapy or neurology and physiotherapy). Comorbidities, such as pain or fatigue and psychiatric comorbidities (anxiety, depression, dissociation etc.) should be carefully evaluated, as they need an individualized treatment path. New FND clinics have been created worldwide over the last decades to offer such multidisciplinary settings and this article will present the experience of a first Swiss FND clinic created in 2016. The aim is to highlight in the form of a narrative review the current literature supporting the usefulness and importance of FND clinics, by reviewing the latest evidence on multidisciplinary interventions in FND.
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P., Pravin, Sanyam Sharma, Sayali Tambe, and Deepali Vora. "Fake News Detector: FND." International Journal of Computer Applications 176, no. 10 (April 15, 2020): 13–17. http://dx.doi.org/10.5120/ijca2020920002.
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Lim, Natalie, Nicholas Wood, Archana Prasad, Karen Waters, Davinder Singh-Grewal, Russell C. Dale, Joseph Elkadi, Stephen Scher, and Kasia Kozlowska. "COVID-19 Vaccination in Young People with Functional Neurological Disorder: A Case-Control Study." Vaccines 10, no. 12 (November 28, 2022): 2031. http://dx.doi.org/10.3390/vaccines10122031.
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Background: The emergence of acute-onset functional neurological symptoms, the focus of this study, is one of three stress responses related to immunisation. This case–control study documents the experience of 61 young people with past or current functional neurological disorder (FND) in relation to the COVID-19 vaccination program in Australia. Methods: Information about the young person’s/parent’s choice and response pertaining to COVID-19 vaccination was collected as part of routine clinical care or FND research program follow-up. Results: 61 young people treated for FND (47 females, mean age = 16.22 years) and 46 healthy controls (34 females, mean age = 16.37 years) were included in the study. Vaccination rates were high: 58/61 (95.1%) in the FND group and 45/46 (97.8%) in the control group. In the FND group, 2 young people (2/61, 3.3%) presented with new-onset FND following COVID-19 vaccination; two young people with resolved FND reported an FND relapse (2/36, 5.56%); and two young people with unresolved FND (2/20, 10.0%) reported an FND exacerbation. In the control group no FND symptoms were reported. Conclusions: Acute-onset FND symptoms following COVID-19 vaccination are uncommon in the general population. In young people prone to FND, COVID-19 vaccination can sometimes trigger new-onset FND, FND relapse, or FND exacerbation.
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Campbell, Malcolm C., Abigail Smakowski, Maya Rojas-Aguiluz, Laura H. Goldstein, Etzel Cardeña, Timothy R. Nicholson, Antje ATS Reinders, and Susannah Pick. "30 Dissociation and its biological and clinical correlates in functional neurological disorder: a systematic review and meta-analysis." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 12 (November 14, 2022): e3.24. http://dx.doi.org/10.1136/jnnp-2022-bnpa.30.
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Objectives/AimsDissociation is a potential mechanism in FND. Although scientific studies report elevated rates of dissociative symptoms in FND, a systematic assessment of the biological and clinical correlates of dissociation in FND is lacking. We aimed to systematically review the current evidence describing dissociative symptoms and disorders in functional neurological disorder (FND), and additionally conduct a meta-analysis of dissociative symptom severity in FND. We also aimed to synthesise the existing data on biological and clinical correlates of dissociation in FND.MethodsWe systematically searched Embase, PsycINFO, and Medline, combining terms for FND and dissociation. Studies were eligible for inclusion if reporting on dissociative symptom scale scores or rates of dissociative disorder in FND samples. Studies were appraised for methodological quality using modified Newcastle-Ottawa criteria. Findings pertaining to dissociative symptoms or disorders, as well as biological and clinical correlates of dissociation in FND samples, were synthesised qualitatively. Dissociative symptom scores were included in a meta-analysis using random and mixed effects models.ResultsTwo-thousand and eighty-eight records were screened and seventy-nine studies were included in the final review. Dissociative symptoms were elevated in FND. The meta-analysis demonstrated a significant elevation in dissociation in FND samples relative to neurological and healthy controls, but not psychiatric controls. Dissociative disorders were frequently co-morbid in FND samples. Psychoform (cognitive) dissociation was more prominent in FND-seizures, whereas somatoform (physical) dissociation tended to be more prominent in FND-motor symptom samples. Dissociation was associated with FND symptom severity or frequency, general psychopathology, and reduced quality of life. Biological correlates of elevated dissociation included structural and functional brain alterations in regions that have previously been implicated in FND, such as the anterior cingulate cortex.ConclusionsDissociative symptoms and disorders are common in FND, and different FND subgroups appear to endorse varying degrees of psychoform or somatoform dissociation. Presence of dissociative symptoms in FND is associated with adverse clinical features; there is therefore a clinical need to assess patients with FND for dissociative symptomatology and to address these symptoms during treatment. Future research should examine dissociation further in different FND subgroups, using measures that distinguish between different types of dissociation, alongside measures of underlying pathophysiology.
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Nakhate, Vihang, Christopher Stephen, David Perez, and Jordan Anderson. "Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department." Seminars in Neurology 39, no. 01 (February 2019): 102–14. http://dx.doi.org/10.1055/s-0038-1676844.
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AbstractFunctional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a “rule-out” diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a “rule-in” diagnosis based on validated neurological examination signs and semiological features. In this perspective article, we review signs and semiological features that can help guide the initial assessment of FND in the acute setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis of FND to patients in the ED, while emphasizing the need for a comprehensive neurological evaluation. Physical and occupational therapy may be useful adjunct assessments in some individuals. Notably, clinicians in the ED setting are important members of the interdisciplinary approach to FND.
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Mark, Victor W. "Functional neurological disorder: Extending the diagnosis to other disorders, and proposing an alternate disease term—Attentionally-modifiable disorder." NeuroRehabilitation 50, no. 2 (March 18, 2022): 179–207. http://dx.doi.org/10.3233/nre-228003.
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BACKGROUND: The term “functional neurological disorder,” or “FND,” applies to disorders whose occurrence of neurological symptoms fluctuate with the patient’s attention to them. However, many other disorders that are not called “FND” nonetheless can also follow this pattern. Consequently, guidelines are unclear for diagnosing “FND.” OBJECTIVE: To review the neurological conditions that follow this pattern, but which have not so far been termed “FND,” to understand their overlap with conditions that have been termed “FND,” and to discuss the rationale for why FND has not been diagnosed for them. METHOD: A systematic review of the PubMed literature registry using the terms “fluctuation,” “inconsistency,” or “attention” did not yield much in the way of these candidate disorders. Consequently, this review instead relied on the author’s personal library of peer-reviewed studies of disorders that have resembled FND but which were not termed this way, due to his longstanding interest in this problem. Consequently, this approach was not systematic and was subjective regarding disease inclusion. RESULTS: This review identified numerous, diverse conditions that generally involve fluctuating neurological symptoms that can vary with the person’s attention to them, but which have not been called “FND.” The literature was unclear for reasons for not referring to “FND” in these instances. CONCLUSION: Most likely because of historical biases, the use of the term “FND” has been unnecessarily restricted. Because at its core FND is an attentionally-influenced disorder that can respond well to behavioral treatments, the field of neurological rehabilitation could benefit by extending the range of conditions that could be considered as “FND” and referred for similar behavioral treatments. Because the term “FND” has been viewed unfavorably by some patients and clinical practitioners and whose treatment is not implied, the alternative term attentionally-modifiable disorder is proposed.
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Baidoo, Lauren. "Functional neurologic disorder (FND) in pediatrics." Nurse Practitioner 47, no. 10 (October 2022): 42–47. http://dx.doi.org/10.1097/01.npr.0000873532.17436.85.
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Pick, Susannah, Morgan Butler, Maya Rojas-Aguiluz, Timothy Nicholson, and H. Laura. "10 State dissociation and interoception in functional neurological disorder." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 8 (July 20, 2020): e4.2-e5. http://dx.doi.org/10.1136/jnnp-2020-bnpa.10.
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Objective/aimsInteroceptive differences have been proposed as an aetiological factor in functional neurological disorder (FND) but there is limited supportive evidence. Previous studies are few, have mixed findings and assessed only (objective) interoceptive accuracy, but not (metacognitive) interoceptive awareness. The aim of this study was to explore interoception in FND in greater detail, by assessing interoceptive accuracy and awareness in individuals with a range of FND presentations. As dissociative symptoms (e.g., depersonalisation, derealisation) are common in FND and could influence interoception, we sought to examine the effects of induced acute dissociation on interoception. We hypothesised that interoceptive accuracy/awareness would be impaired at baseline in FND relative to healthy controls, but that the differences would be exacerbated following dissociation induction.MethodsTwenty adults with FND were recruited from online FND support groups. Diagnosis was confirmed by medical documentation from a relevant healthcare professional. The FND group was compared to a group of 20 healthy controls recruited from online community groups. A modified heart-beat tracking task measured interoceptive accuracy (correct detection of heart beats) and awareness (confidence judgements). A control task involved counting visually presented geometric shapes. Both tasks were completed before and after a validated dissociation induction procedure (mirror-gazing).ResultsThe FND group reported elevated dissociation at baseline relative to controls (p<0.01) but this difference was larger following mirror-gazing (p<0.001). Interoceptive accuracy did not differ significantly between groups at baseline; however, the FND group had significantly lower accuracy scores following mirror-gazing (p<0.05). There was no effect of group on shape counting accuracy at either timepoint. Confidence ratings on the interoception and shape counting tasks were significantly lower at both timepoints in the FND group relative to controls (all p-values <0.05 or <0.01).ConclusionsIndividuals with FND reported elevated dissociation both before and after a dissociation induction procedure, although this was exacerbated post-dissociation induction. In contrast, interoceptive accuracy was unimpaired at baseline, but impaired following dissociation induction, relative to controls. The FND group showed reduced metacognitive awareness for detection of bodily states and external (visual) stimuli. Future research should better determine the nature of interoceptive deficits in FND and assess the impact of dissociation on a range of cognitive and affective processes relevant to the disorder.
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Mason, Isabel, Laura McWhirter, Alan Carson, Jon Stone, and Ingrid Hoeritzauer. "28 Functional neurological disorder in the chronic pain clinic; a retrospective study of comorbidity." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 12 (November 14, 2022): e3.21. http://dx.doi.org/10.1136/jnnp-2022-bnpa.28.
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Objectives/AimsChronic pain is commonly reported as a comorbidity in patients with functional neurological disorder (FND) however the prevalence of FND in those presenting with chronic pain is unknown. We aimed to estimate 1) the prevalence of FND in patients seen at a chronic pain clinic and 2) how patients with chronic pain and comorbid FND differ from those without FND in terms of pain characteristics, psychiatric comorbidity, pain management and pain outcome.MethodsRetrospective electronic records review of consecutive new patients attending chronic pain clinics of 8 pain specialists in Lothian from the 1st of August 2019 to the 19thSeptember of 2019. Mean duration of follow up was 25 months. We recorded the clinical features, medication, management and outcome of chronic pain, any lifetime (up to November 2021) diagnoses of functional, FND and psychiatric disorders and undiagnosed neurological symptoms (where it was unclear if symptoms related to FND or another condition).ResultsOf 190 patients attending a chronic pain clinic, 32 (17%) had at least one lifetime diagnosis of FND and an additional 8 (4%) had undiagnosed neurological symptoms. FND diagnoses were functional limb weakness (8%), functional sensory disorder (8%), dissociative seizures (6%), functional cognitive disorder (5%), functional movement disorder (4%) and others (2%). Chronic primary pain (p<0.001), widespread chronic primary pain (p<0.00001) and pain with no precipitating trigger (p<0.01) were more common in pain patients with comorbid FND. A history of depression (p<0.001), anxiety (p<0.05) and suicide attempt (p<0.05) were also more common in these patients. However, patients with chronic pain and comorbid FND did not differ significantly from patients without FND in age, gender, prescribed analgesia (opiates and benzodiazepines) or pain outcome (25% vs 34% pain improved).ConclusionsFND was found in a surprisingly high 17% of new patients at a chronic pain clinic. This may be an underestimate based on an additional 4% of patients with undiagnosed neurological symptoms. Patients with chronic pain and FND are significantly more likely to have chronic primary pain compared to other pain patients but do not experience different pain management or outcome. These results provide further evidence of the important overlap between FND and chronic pain conditions.
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Pick, Susannah, David G. Anderson, Ali A. Asadi-Pooya, Selma Aybek, Gaston Baslet, Bastiaan R. Bloem, Abigail Bradley-Westguard, et al. "Outcome measurement in functional neurological disorder: a systematic review and recommendations." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 6 (February 28, 2020): 638–49. http://dx.doi.org/10.1136/jnnp-2019-322180.
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ObjectivesWe aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes.MethodsA systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group.ResultsFive FND-specific measures were identified—three clinician-rated and two patient-rated—but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost–utility (eg, healthcare resource use and quality-adjusted life years).ConclusionsThere are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population.
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Popkirov, Stoyan, Ingrid Hoeritzauer, Lesley Colvin, Alan J. Carson, and Jon Stone. "Complex regional pain syndrome and functional neurological disorders – time for reconciliation." Journal of Neurology, Neurosurgery & Psychiatry 90, no. 5 (October 24, 2018): 608–14. http://dx.doi.org/10.1136/jnnp-2018-318298.
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There have been many articles highlighting differences and similarities between complex regional pain syndrome (CRPS) and functional neurological disorders (FND) but until now the discussions have often been adversarial with an erroneous focus on malingering and a view of FND as ‘all in the mind’. However, understanding of the nature, frequency and treatment of FND has changed dramatically in the last 10–15 years. FND is no longer assumed to be only the result of ‘conversion’ of psychological conflict but is understood as a complex interplay between physiological stimulus, expectation, learning and attention mediated through a Bayesian framework, with biopsychosocial predisposing, triggering and perpetuating inputs. Building on this new ‘whole brain’ perspective of FND, we reframe the debate about the ‘psychological versus physical’ basis of CRPS. We recognise how CRPS research may inform mechanistic understanding of FND and conversely, how advances in FND, especially treatment, have implications for improving understanding and management of CRPS.
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Nicholson, Clare, Mark J. Edwards, Alan J. Carson, Paula Gardiner, Dawn Golder, Kate Hayward, Susan Humblestone, et al. "Occupational therapy consensus recommendations for functional neurological disorder." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 10 (July 30, 2020): 1037–45. http://dx.doi.org/10.1136/jnnp-2019-322281.
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BackgroundPeople with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention.MethodsThe recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved.ResultsWe recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document.ConclusionsOccupational 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.
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Symeon, C., A. Isaacs-Itua, and A. Saramandi. "8 Functional neurological disorder (FND) patients’ experience of healthcare interventions." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 8 (July 20, 2020): e11.1-e11. http://dx.doi.org/10.1136/jnnp-2020-bnpa.26.
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ObjectivesDespite Functional Neurological Disorder (FND) accounting for approximately 25% of Neurology out-patient appointments, and being frequently comorbid with other neurological conditions, there are only 4 centres in the UK, offering in-patient treatment programmes. Subsequently, services are strained as patients face long waiting lists and likely deterioration of symptoms. We explored patients’ experience of this and the impact on their wellbeing.MethodsAn on-line survey was sent to patients with a diagnosis of FND, who had, at out- patient assessment been deemed appropriate candidates for in-patient rehabilitation, and had provided written consent to be included in research. The survey question themes included: demography, understanding of FND diagnosis, subjective opinion of symptom progression, use of primary care services and/or Emergency Departments, and access to support and employment opportunities.Response where subjective opinion was sought, e.g. understanding of diagnosis, was via Likert scale ratings (from 0 (no understanding at all) to 10 (full understanding). All responses were anonymous.Results12 patients completed the survey (n=12). Of these, 7 were female and 5, male. 11 patients were aged between 25–64 years and 1, aged over 65 years. More than half of patients had seen their GP or visited an Emergency Department with symptoms related to FND in the past year. Average understanding of FND diagnosis was rated as 6.5, of treatment options as 4.8 and confidence of the likelihood of full recovery as 3.5 (on a scale of 0–10). 7 patients had carers, of whom the majority were family members. 9 patients would consider the use of digital interventions or day therapy programmes and 10 patients had already completed an in-patient rehabilitation programme. Of these, 9 had been on the in-patient waiting list for over 6 months. 8 patients felt that their symptoms had deteriorated and 6 patients described their level of independence, as being ‘much worse’, while on the waiting list.ConclusionsWhile we appreciate that this is a small sample size, it does offer invaluable insight into the experiences of those with FND, particularly with regards to healthcare intervention. Patients with FND inevitably use what would be regarded as high levels of healthcare intervention, although this must be considered within the context of limited healthcare resources available to them.
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Nash, Will, Jasmine Bavington, and Jan Coeburgh. "33 The link between migraine and functional neurological disorder." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 12 (November 14, 2022): e3.27. http://dx.doi.org/10.1136/jnnp-2022-bnpa.33.
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Objective/AimsTo determine the prevalence of migraine in functional neurological disorder (FND) (data still to collect). Of which patients with concomitant migraine and FND, what proportion ofpatients have adequate migraine treatment and prophylaxis.MethodsPatient data was collected from clinic letters, ‘migraine’ was cross referenced across all electronic clinic letters from a regional functional neurology clinic between 2018–2019.The number of patients with and without holistic migraine treatment, appropriate attack treatment and prophylactic treatment was recorded. The predisposing, precipitating and perpetuating factors for patients’ FND was also recorded.By cross referencing ‘functional neurological disorder’ across the electronic clinic letters over the same period then prevalence data was obtained (data still to collect)Results50 patients with FND over the study period were identified to have a history of migraine, with 48 reporting active migraine and 2 reporting previous migraine.Of these 39 had inadequate attack treatment, and 31 had inadequate migraine prophylaxis.Migraine is a predisposing, precipitating and largely a perpetuating factor in 6, 8 and 24 FND patients respectively.Migraine as a contributing perpetuating factor for FND in 24 patients was more common than other factors: 6 patients had anxiety, 5 patients had a mood disorder, and 3 patients had a traumatic life event.ConclusionsThere is minimal literature on the link between undertreated migraine and functional neurological disorder.These results suggest an overall lack of treatment control of migraine in FND patients.Seeing as migraine can play a role in predisposing, precipitating and perpetuating migraine it shows the importance of treating FND patients holistically.It shows the importance of early detection, asking FND patients about migraine symptoms and ensuring treatment regimens are in place.In the future, larger scale research into the link between migraine and FND will improve patient quality of life and how we treat functional neurological disorders.
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Khoja, Lujain A., Jan Coebergh, and Timothy R. Nicholson. "28 The link between functional neurological disorder (FND) & migraine: a systematic review." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 8 (July 20, 2020): e19.2-e19. http://dx.doi.org/10.1136/jnnp-2020-bnpa.45.
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BackgroundFND and migraine are both common disorders that occur in the absence of structural brain damage. Clinically, it is suspected that they might co- occur more often than would be expected by chance. It is important to distinguish them in some clinical situations, especially hemiplegic migraine from migraine that triggers FND with weakness but there are no systematic, and limited narrative reviews of the topic.ObjectivesTo study the association of FND and migraine with a systematic review of the literature.MethodsSearches for relevant literature were performed in July 2018 in MEDLINE and PsycINFO electronic databases without time limitation and augmented by hand searching the reference lists within these papers and the knowledge of literature from selected experts in the fieldResultsFive studies were identified; two from electronic, one from hand searches and two from experts. The total number of the sample size from the included studies was 2385. Findings generally indicated a positive association between migraine and FND. A prospective epidemiological study found that number of FND symptoms reported by migraineurs was 2.2 and 1.1 on controls. In a retrospective review of medical report study functional movement disorders occurred within 6 months or concomitantly with migraine onset in 71% of chronic migraine (CM) & 87.5% episodic migraine (EM) cases and the outcome effect of treating migraine on FND symptoms was a decrease or remission in 91% in CM and by 67% in EM. In a retrospective chart review study in the epilepsy monitoring unit, migraine diagnosis had a predictive value for diagnosing PNES & epilepsy OR=1.83, p<0.037 (95% CI: 1.04–3.32) compared to other biological factors. 40% of people diagnosed with FND reported having headache compared to 9% of controls in patients with other neurological disorders (P<0.0001). Unpublished data from a case-control study by Stone et al, revealed that 36% of 107 FND patients with limb weakness experienced migraine. Additionally, a clinical-based observational study from India of 1000 patients highlighted the common occurrence of psychogenic non-epileptic seizures (PNES) during acute migraine attacks.ConclusionsDespite a limited evidence base, migraine and FND appear to co-occur at elevated rates. It is imperative to explore how treating either migraine or FND impacts on the other. More studies are needed to confirm these findings and to investigate any potential mechanistic overlap.
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Moffat, Stephanie M., Jeffrey C. Posnick, Gaylene E. Pron, and Derek C. Armstrong. "Frontonasal and Craniofrontonasal Dysplasia: Preoperative Quantitative Description of the Cranio-Orbito-Zygomatic Region Based on Computed and Conventional Tomography." Cleft Palate-Craniofacial Journal 31, no. 2 (March 1994): 97–105. http://dx.doi.org/10.1597/1545-1569_1994_031_0097_facdpq_2.3.co_2.
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The unoperated cranio-orbito-zygomatic complex of 18 children (mean 4.7 years) with frontonasal dysplasia (FND) and 12 children (mean 1.1 years) with craniofrontonasal dysplasia (CFND) was quantified by 15 standard measurements performed on either computed tomography scans or facial tomograms. The results were compared with age-matched control values. In the FND group, the mean anterior interorbital and mid-interorbital distances were significantly increased at 148% and 118% of normal, and in the CFND patients, at 177% and 140% of normal. Excessive medial orbital wall protrusion (mean, 145% of normal in FND and 177% in CFND), shortened zygomatic arch lengths (mean, 94% of normal In FND and 91% in CFND), and reduced cephalic lengths (mean, 96% of normal in FND and 83% in CFND) were all observed. An expanded interzygomatic buttress distance was documented only in the CFND group, at 111% of normal. The clinical presentation of craniofacial deformities such as FND and CFND can be objectively described by a numerical analysis of the bony pathology.
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Perez, David L., Ann Hunt, Nutan Sharma, Alice Flaherty, David Caplan, and Jeremy D. Schmahmann. "Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training." Neurology: Clinical Practice 10, no. 6 (December 4, 2019): 484–87. http://dx.doi.org/10.1212/cpj.0000000000000779.
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Functional neurologic disorder (FND), although neglected for much of the 20th century, is among the most common conditions encountered by neurologists across clinical settings. High prevalence rates and limited provider expertise in FND have created a considerable need to develop educational initiatives and practical suggestions to guide neurologists in training working with this population. To help avoid diagnostic errors, trainees should keep in mind that (1) marginally positive functional examination signs have low specificity; (2) FND can coexist with other neurologic comorbidities; and (3) bizarre, not previously encountered, neurologic presentations should not be mistakenly diagnosed as FND. Furthermore, trainees should be encouraged to longitudinally follow in their clinics a subset of patients with FND to develop the interview, diagnostic, and neuropsychiatric skills needed to effectively care for this population. As the landscape of neurologic care evolves, neurologists with expertise in FND should advise on shaping elements of the educational curriculum for neurology residents.
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Hagemeister, F. B., P. McLaughlin, L. Fayad, F. Samaniego, N. Dang, A. Goy, J. Romaguera, et al. "Rituximab, Fludarabine, Mitoxantrone, and Dexamethasone (R-FND) for Relapsed Indolent Lymphomas (RIL)." Blood 106, no. 11 (November 16, 2005): 941. http://dx.doi.org/10.1182/blood.v106.11.941.941.
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Abstract Optimal therapy for patients (pt) with B-cell RIL remains controversial, and many treatment options include rituximab (R). Based on phase I–II studies of FND (fludarabine 25 mg/m2, d1–3; mitoxantrone 10 mg/m2, d1; dexamethasone 20 mg d1–5) treatment for RIL in which we observed a 48% CR rate, we studied the combination of R (375 mg/m2 d1) and FND for pt with RIL. Pt could not have received prior fludarabine, and were eligible if they had not previoiusly received R or had a response lasting at least 6 months (mo) to prior treament with R. Cycles were repeated every 4 weeks, and required an absolute neutrophil count of 1,000 and a platelet count of 100,000 to administer each cycle. Forty-two pt were entered onto this trial; however, one never received therapy after signing consent, and two were deemed ineligible after signing consent because of low cardiac ejection fractions (EF). All pt underwent biopsy prior to therapy; histologies included follicular gr1–3 in 30 pt, small lymphocytic in 7, marginal zone in 2. The median age was 58 (range 39–84) and median prior therapies 1 (range 1–3). The median number of cycles of R-FND delivered per patient was 6 (range 1–8). Of the 39 eligible and evaluable pt, 19 entered CR and 9 CRu for a CR/CRu rate of 72%, and 9 entered PR (23%) for an overall response rate of 95%. One had stable disease (SD), and one progression (PD). Eight underwent high dose therapy followed by autologous stem cell transplant (SCT) following a response to R-FND therapy. Five of these had achieved CR/CRu with R-FND after 1–6 cycles, and 3 PR after 2–6 cycles. In all, 14 of the 37 responders to R-FND (37%) have had progression; however, none of the 8 who underwent SCT has had progression, nor has the one with SD. In, 24 (62%) still remain free of progression with a median follow-up for living pt of 32 mo. In all, 6 pt have died of PD, including 4 who were ineligible for or refused SCT. The 2-year failure-free survival (FFS) and overall survival (OS) results for all pt are 66% and 90%. The 2-year FFS for responders is 66%, and the 2-year OS for all pt, with pt undergoing SCT censored at time of SCT is 81%. As expected, the main toxicity following R-FND was hematologic: gr 4 neutropenia occurred in 15 pt and in 15 of 130 cycles for which information is available, and gr 3–4 thrombocytopenia in 5 pt and in 6 cycles. In all, 13 of the 28 responders received less than 6 cycles of therapy; reasons included prolonged thrombocytopenia in 4, early SCT in 6, asymptomatic decrease in EF in one, and physician’s choice in 2. No patients died of acute toxicity while receiving R-FND. We conclude that 1) R-FND is a very active and well tolerated regimen for relapsed indolent lymphomas 2) Results appear very favorable compared to prior studies with FND 3) In this population, patients receiving R-FND were able to undergo SCT, and had very favorable outcomes.
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OKeeffe, Shauna, Ibrahim Chowdhury, Anila Sinanaj, Iberedem Ewang, Camilla Blain, Tiago Teodoro, Mark Edwards, and Mahinda Yogarajah. "#3100 A service evaluation of the experiences of patients with functional neurological disorders within the NHS." Journal of Neurology, Neurosurgery & Psychiatry 92, no. 8 (July 16, 2021): A15.2—A15. http://dx.doi.org/10.1136/jnnp-2021-bnpa.34.
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Objectives/AimsPrevious research into Functional Neurological Disorder (FND) has shown that there are significant barriers in providing multidisciplinary, patient-centred care for these patients, including stigmatising attitudes, poor knowledge about FND, and a lack of structured care pathways. However, there has been no specific research into patient experiences of care for FND within NHS services to date, and whether these experiences meet the standards of care expected for long-term neurological conditions (LTNCs). The current study thus aimed to investigate the types of problems experienced by FND patients, and whether they differed in frequency and type to patients with another LTNC, multiple sclerosis (MS).MethodsBoth FND (n = 40) and MS patients (n = 37) were recruited from tertiary neurology clinics at an NHS hospital and completed two questionnaires on their experiences of health and social care services and on their level of disability.ResultsThe results indicated significant differences in experiences of care between the two patient groups, with FND patients reporting significantly more problems (p<0.001)overall. These problems were reported in relation to their diagnosis and treatment, relationships with healthcare professionals, and difficulties in accessing services. This was despite FND patients reporting significantly higher levels of disability (p=0.001), highlighting the burden of care experienced by FND patients as a result of these difficulties in accessing and receiving care. A small sample size, specificity to a single neurology centre, and a cross-sectional design are acknowledged as limitations.ConclusionsTogether, these results suggest that current care for FND patients is not meeting the standards expected for LTNCs, and highlight the need for further research and the development of structured, multidisciplinary pathways with a patient-centred approach.
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Samani, Narissa, Annmarie Burns, and Joanne Chan. "A pre-post study investigating the effectiveness of functional neurological disorder (FND) training to increase healthcare staff’s knowledge, and confidence in FND management." Neuropsychologist 1, no. 14 (October 2022): 27–36. http://dx.doi.org/10.53841/bpsneur.2022.1.14.27.
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Educational interventions aimed at improving healthcare professionals’ (HCPs) knowledge and confidence in managing complex conditions are widely recommended. However, there is limited evidence regarding the impacts of such interventions on HCP confidence and knowledge in relation to the management of Functional Neurological Disorder (FND). This investigation aimed to ascertain whether a two-hour FND training session, delivered online in group format, improved HCP confidence and knowledge in FND management, using a pre-post repeated measures design. Responses from 25 HCPs from community-based rehabilitation services at Whittington Health NHS Trust were included in the analysis. The findings indicated significant improvements in participant confidence and knowledge scores following training, suggesting the potential value of accessible low-cost training within the NHS. Future studies could adopt a randomised controlled trial design to reliably determine the effectiveness of delivering the training.
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Hryshchuk, Oksana. "PRINCIPLES OF LAW: PHILISOPHICAL FND LEGAL ASPECTS." Visnyk of the Lviv University. Series Law, no. 61 (September 10, 2015): 16–23. http://dx.doi.org/10.30970/vla.2015.61.190.
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Arbuckle, Amanda L., Emily C. Bihun, Bradley L. Schlaggar, and Kevin J. Black. "Functional tic-like presentations differ strikingly from Provisional Tic Disorder." F1000Research 11 (December 22, 2022): 1566. http://dx.doi.org/10.12688/f1000research.129252.1.
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Background: Recent years have seen a dramatic increase in new “tic” cases in teens and young adults. These individuals often present with fulminant onset of symptoms not commonly seen in Tourette syndrome (TS) and are often diagnosed with Functional Neurological Symptom Disorder (FND-tic). However, some authors have questioned whether this illness truly differs from typical Provisional Tic Disorder (PTD) and TS. Previous studies have compared FND-tic, usually a few months after symptom onset, to patients with TS, usually years after symptom onset. We sought to test whether the presenting symptoms of FND-tic differ substantially from those in patients at a similar duration of symptoms who are later diagnosed with TS. Methods: This comparative study examines clinical features summarized from published reports of FND-tic with novel data from a longitudinal study of PTD. This study came from a referral center for TS and tic disorders and included 89 children with tics whose first tic occurred a median of 3.6 months earlier, nearly all of whom were diagnosed with a chronic tic disorder at follow-up. Specifically, we examine clinical features identified in a recent literature review as supporting a diagnosis of FND-tic, including symptom characteristics, course, severity and comorbidity. Results: Several clinical features dramatically distinguish the patients diagnosed with FND-tic from those diagnosed with typical PTD. For example, coprophenomena are reported at or shortly after symptom onset in over half of FND-tic patients, whereas even several months after onset, coprophenomena had occurred in only 1 of 89 children with PTD. Six clinical features each have a positive predictive value over 90% for FND-tic diagnosis if prior probability is 50%. Conclusions: These new data provide strong evidence supporting the diagnostic validity of FND-tic as distinct from TS.
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Zohar, Yuval, Rima Sadov, Michael Strauss, Ghideon Sabo, Reni Sabo, and Johnathan Lehman. "Internal Jugular Vein Patency after Functional Neck Dissection: Venous Duplex Imaging." Annals of Otology, Rhinology & Laryngology 104, no. 7 (July 1995): 532–36. http://dx.doi.org/10.1177/000348949510400706.
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We present a retrospective study performed to determine jugular patency after functional neck dissection (FND). Twenty-six patients, 16 females and 10 males, ranging in age from 16 to 78 were examined. These patients underwent either unilateral FND or bilateral FND for cervical lymph node metastases. Cervical duplex and pulsed Doppler imaging were chosen to determine internal jugular vein (IJV) patency. The examination was performed after a minimum postoperative period of 2 months and a maximum one of 22 years. Thirty-one IJVs were examined. All but 4 IJVs examined were found patent postoperatively. The preservation rate of patency of the IJV in FND was found to be high (27 of 31 or 87%). These results favor the use of FND for IJV preservation, particularly in bilateral neck dissection.
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Gardiner, Paula, Lindsey MacGregor, Alan Carson, and Jon Stone. "Occupational therapy for functional neurological disorders: a scoping review and agenda for research." CNS Spectrums 23, no. 3 (November 27, 2017): 205–12. http://dx.doi.org/10.1017/s1092852917000797.
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Functional neurological disorders (FND)—also called psychogenic, nonorganic, conversion, and dissociative disorders—constitute one of the commonest problems in neurological practice. An occupational therapist (OT) is commonly involved in management, but there is no specific literature or guidance for these professionals. Classification now emphasizes the importance of positive diagnosis of FND based on physical signs, more than psychological features. Studies of mechanism have produced new clinical and neurobiological ways of thinking about these disorders. Evidence has emerged to support the use of physiotherapy and occupational therapy as part of a multidisciplinary team for functional movement disorders (FMD) and psychotherapy for dissociative (nonepileptic) attacks. The diagnosis and management of FND has entered a new evidence-based era and deserves a standard place in the OT neurological curriculum. We discuss specific management areas relevant to occupational therapy and propose a research agenda.
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Keynejad, Roxanne C., Thomas Frodl, Richard Kanaan, Carmine Pariante, Markus Reuber, and Timothy R. Nicholson. "Stress and functional neurological disorders: mechanistic insights." Journal of Neurology, Neurosurgery & Psychiatry 90, no. 7 (November 8, 2018): 813–21. http://dx.doi.org/10.1136/jnnp-2018-318297.
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At the interface between mind and body, psychiatry and neurology, functional neurological disorder (FND) remains poorly understood. Formerly dominant stress-related aetiological models have been increasingly challenged, in part due to cases without any history of past or recent trauma. In this perspective article, we review current evidence for such models, and how research into the role of traumatic stress in other disorders and the neurobiology of the stress response can inform our mechanistic understanding of FND. First, we discuss the association between stress and the onset or exacerbation of a variety of physical and mental health problems. Second, we review the role of hypothalamic-pituitary-adrenal axis dysfunction in the neurobiology of ill-health, alongside evidence for similar mechanisms in FND. Third, we advocate a stress-diathesis model, in which biological susceptibility interacts with early life adversity, where FND can be precipitated by traumatic events later in life and maintained by psychological responses. We hypothesise that greater biological susceptibility to FND is associated with less severe remote and recent stress, and that FND precipitated by more severe stress is associated with lower biological vulnerability. This would explain clinical experience of variable exposure to historical and recent traumatic stress among people with FND and requires empirical investigation. A testable, evidence-based stress-diathesis model can inform nuanced understanding of how biological and psychological factors interact at the individual level, with potential to inform personalised treatment pathways. Much-needed research to establish the aetiology of FND will enhance clinical care and communication, facilitate effective treatment and inform prevention strategies.
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Pick, Susannah, Laura H. Goldstein, David L. Perez, and Timothy R. Nicholson. "Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda." Journal of Neurology, Neurosurgery & Psychiatry 90, no. 6 (November 19, 2018): 704–11. http://dx.doi.org/10.1136/jnnp-2018-319201.
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Functional neurological disorder (FND) is a common and highly disabling disorder, but its aetiology remains enigmatic. Conceptually, there has been reduced emphasis on the role of psychosocial stressors in recent years, with a corresponding increase in neurobiological explanations. However, a wealth of evidence supports the role of psychosocial adversities (eg, stressful life events, interpersonal difficulties) as important risk factors for FND. Therefore, there is a need to integrate psychosocial (environmental) and neurobiological factors (eg, sensorimotor and cognitive functions) in contemporary models of FND. Altered emotional processing may represent a key link between psychosocial risk factors and core features of FND. Here, we summarise and critically appraise experimental studies of emotional processing in FND using behavioural, psychophysiological and/or neuroimaging measures in conjunction with affective processing tasks. We propose that enhanced preconscious (implicit) processing of emotionally salient stimuli, associated with elevated limbic reactivity (eg, amygdala), may contribute to the initiation of basic affective/defensive responses via hypothalamic and brainstem pathways (eg, periaqueductal grey). In parallel, affect-related brain areas may simultaneously exert a disruptive influence on neurocircuits involved in voluntary motor control, awareness and emotional regulation (eg, sensorimotor, salience, central executive networks). Limbic-paralimbic disturbances in patients with FND may represent one of several neurobiological adaptations linked to early, severe and/or prolonged psychosocial adversity. This perspective integrates neurobiological and psychosocial factors in FND and proposes a research agenda, highlighting the need for replication of existing findings, multimodal sampling across emotional response domains and further examination of emotional influences on sensorimotor and cognitive functions in FND populations.
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Tsimberidou, Apostolia M., Peter McLaughlin, Anas Younes, Maria A. Rodriguez, Fredrick B. Hagemeister, Andreas Sarris, Jorge Romaguera, et al. "Fludarabine, mitoxantrone, dexamethasone (FND) compared with an alternating triple therapy (ATT) regimen in patients with stage IV indolent lymphoma." Blood 100, no. 13 (December 15, 2002): 4351–57. http://dx.doi.org/10.1182/blood-2001-12-0269.
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Treatment for patients with stage IV indolent lymphoma ranges from watchful waiting to intensive chemotherapy and stem cell transplantation. In this trial we compared 2 induction regimens followed by 1 year of interferon maintenance therapy. Fludarabine, mitoxantrone (Novantrone), and dexamethasone (FND) were compared with an alternating triple therapy (ATT) regimen (CHOD-Bleo, ESHAP, and NOPP). Maintenance interferon/dexamethasone was given for 1 year in both treatment arms. Endpoints were comparisons of remission rates, survival, failure-free survival (FFS), molecular response rates, and toxicities. One hundred forty-two patients with previously untreated stage IV indolent lymphoma were evaluable (73 on FND; 69 on ATT). The overall response rates were 97% for FND and 97% for ATT (P = .9). The median follow-up is 5.9 years. The 5-year survival rates were 84% with FND and 82% with ATT (P = .9); the 5-year FFS rates were 41% with FND and 50% with ATT (P = .02). In a multivariate analysis, factors predicting for longer FFS were β2-microglobulin less than 3 mg/L (P = .01) and ATT treatment (P = .03). ATT was associated with a substantially higher rate of grade 3-4 toxicities than FND. In conclusion, both regimens were associated with high rates of response and survival. ATT was associated with substantially longer FFS, but it was more toxic than FND.
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Polich, Ginger, Stacey Zalanowski, Julie Maney, David L. Perez, Gaston Baslet, Julie Maggio, Mary A. O’Neal, Barbara Dworetzky, and Seth Herman. "Development of an inpatient rehabilitation pathway for motor functional neurological disorders: Initial reflections." NeuroRehabilitation 50, no. 2 (March 18, 2022): 231–43. http://dx.doi.org/10.3233/nre-228006.
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BACKGROUND: Emerging research supports a primary role for rehabilitation therapy alongside psychoeducation and psychotherapy in the treatment of functional neurological disorder (FND). OBJECTIVE: While consensus recommendations for physical therapists, occupational therapists, and speech and language pathologists treating FND have been published, specific recommendations for multidisciplinary FND care delivered on an inpatient rehabilitation unit are yet to be established. METHODS: This report describes one inpatient rehabilitation facility’s efforts to design and implement a clinical pathway for patients with acute-onset motor FND—patients recently hospitalized for work-up of new neurological symptoms subsequently deemed functional. RESULTS: Detailed descriptions on defining admission criteria and delivering consensus- and evidence-based multidisciplinary inpatient rehabilitation are provided. CONCLUSIONS: In the context of prospective research studies, considerably more work is needed to delineate the optimal duration and intensity of inpatient rehabilitation treatment for the management of patients with motor FND.
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Koo, Kyung-Mo, and Eui-Young Cha. "Smartphone Based FND Recognition Method using sequential difference images and ART-II Clustering." Journal of the Korean Institute of Information and Communication Engineering 16, no. 7 (July 31, 2012): 1377–82. http://dx.doi.org/10.6109/jkiice.2012.16.7.1377.
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Do, Trung Kien, Nguyen Thi Thanh Nga, Nguyen Quynh Anh, Dinh Minh Pham, and Chu Hoang Ha. "ID: 1037 Effect of fluorescent nanodiamonds on umbilical cord mesenchymal stem cell differentiation into hepatocyte-like cell." Biomedical Research and Therapy 4, S (September 5, 2017): 115. http://dx.doi.org/10.15419/bmrat.v4is.313.
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Fluorescent nanodiamond (FND) indicated that it has excellent biocompatibility and photostability,so it well suited for long-term labeling and tracking of stem cells. There are many reports concerning the factors controlling stem cell differentiation. However, still little knowledge about the biomaterials properties influence stem cell alive, growth and differentiation processing. In this study, we evaluate the effect of fluorescent nanodiamond in in vitro culture and differentiation of ucMSC into hepatocyte-like cell. Mesenchymal stem cells (MSCs) were isolated from the umbilical cord (UC) and CD markers were analyzed by flow cytometry and genes expression. For hepatic differentiation of UC-MSCs, cells were induced with HGF and DMSO treated. FND was supply in the experimental group which 10 g/ml in 4 hours. The FND uptake was detected of fluorescence intensity of FND in cells by flow cytometry and laser scan microscopy. The effect of FND into UCMSCs was not only evaluated by the cell alive and growth assay but also effective differentiation throughout morphology charging or gene expression levels of AFP, ALB, and HNF4 were determined by RT-PCR and real-time PCR. The result showed that the FND was well uptake in UCMSCs. It was no affected into ability of the cell alive and growth. The existence of FNDs does not disturb the functions of UC-MSCs differentiation into hepatocyte-like cell. FND can be utilized for the labeling and tracking of UC-MSCs and hepatocyte-like cell in homing research.
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Gutkin, Myles, Loyola McLean, Richard Brown, and Richard A. Kanaan. "Systematic review of psychotherapy for adults with functional neurological disorder." Journal of Neurology, Neurosurgery & Psychiatry 92, no. 1 (November 5, 2020): 36–44. http://dx.doi.org/10.1136/jnnp-2019-321926.
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Functional neurological disorder (FND) is a common and disabling disorder that is often considered difficult to treat, particularly in adults. Psychological therapies are often recommended for FND. Outcome research on psychological therapies for FND has grown in recent years but has not been systematically evaluated since 2005. This study aims to build on that by systematically reviewing the evidence-base for individual outpatient cognitive behavioural and psychodynamic psychotherapies for FND. Medical databases were systematically searched for prospective studies of individual outpatient psychotherapy for FND with at least five adult participants. Studies were assessed for methodological quality using a standardised assessment tool. Results were synthesised, and effect sizes calculated for illustrative purposes. The search strategy identified 131 relevant studies, of which 19 were eligible for inclusion: 12 examining cognitive behavioural therapy (CBT) and 7 investigating psychodynamic therapy (PDT). Eleven were pre–post studies and eight were randomised controlled trials. Most studies recruited a single symptom-based subtype rather than all presentations of FND. Effect sizes, where calculable, showed generally medium-sized benefits for physical symptoms, mental health, well-being, function and resource use for both CBT and PDT. Outcomes were broadly comparable across the two therapy types, although a lack of high-quality controlled trials of PDT is a significant limitation, as is the lack of long-term follow-up data in the majority of identified CBT trials. In conclusion, both CBT and PDT appear to potentially offer some benefit for FND, although better quality studies are needed.
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Leandertz, Mikaela, Jussi Joukainen, Tuula Pesonen, and Esa Ala-Ruona. "Psychotherapeutically Oriented Vibroacoustic Therapy for Functional Neurological Disorder: A Pilot Study." Music and Medicine 13, no. 1 (January 23, 2021): 20–30. http://dx.doi.org/10.47513/mmd.v13i1.754.
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Functional Neurological Disorder (FND) affects a significant number of people worldwide. Previously referred to as conversion disorder, FND is a disorder of the communication between mind and body resulting in the experience of neurological symptoms incompatible with neurological or medical diagnoses. FND patients account for a notable portion of neurologists' patients, and yet these patients are still considered some of the most difficult to diagnose and treat. This pilot case study utilized a psychotherapeutically oriented approach to vibroacoustic therapy and active music therapy methodology in the therapy process of a patient diagnosed with FND. The treatment protocol used in this study highlights an interdisciplinary, multimodal, and diverse approach to referral and treatment for FND patients. Review of the qualitative data together with the quantitative outcomes of the study provided a comprehensive conceptualization of this case. Valuable perspectives were gained from this approach, and the clinical findings were well supported by the quantitative outcome measures.
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Adams, Caitlin, Jordan Anderson, Elizabeth N. Madva, W. Curt LaFrance Jr, and David L. Perez. "You’ve made the diagnosis of functional neurological disorder: now what?" Practical Neurology 18, no. 4 (May 15, 2018): 323–30. http://dx.doi.org/10.1136/practneurol-2017-001835.
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Patients with functional neurological disorders (FND)/conversion disorder commonly present to outpatient clinics. FND is now a ‘rule in’ diagnosis based on neurological examination findings and semiological features. While neurologists may be more comfortable diagnosing patients with FND, there is only limited guidance as to how to conduct follow-up outpatient visits. Using clinical vignettes, we provide practical suggestions that may help guide clinical encounters including how to: (1) explore illness beliefs openly; (2) enquire longitudinally about predisposing vulnerabilities, acute precipitants and perpetuating factors that may be further elucidated over time; (3) facilitate psychotherapy engagement by actively listening for potentially unhelpful or maladaptive patterns of thoughts, behaviours, fears or psychosocial stressors that can be reflected back to the patient and (4) enquire about the fidelity of individual treatments and educate other providers who may be less familiar with FND. These suggestions, while important to individualise, provide a blueprint for follow-up FND clinical care.
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Dadah, Hashim, Uzoma Anthony-Uzoeto, Sadat Yazdouni, Ali Aweis-Asanga, Alan Dunlop, and Rafey Faruqui. "A prescription of information – promoting symptom self-management in people with functional neurological disorder (FND)." BJPsych Open 7, S1 (June 2021): S182. http://dx.doi.org/10.1192/bjo.2021.493.
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AimsFunctional Neurological Disorder (FND) is known to be associated with high healthcare resource utilisation and poor quality of life. Patients’ understanding of the disorder is considered instrumental in improving prognosis.We produced a symptom self-management patient education strategy with a booklet and FND symptoms recording template in a community neuropsychiatry setting. We embedded this psychoeducation intervention in a post-nursing triage model of care.MethodA co-production cycle of patient education material was implemented as part of a Quality Improvement Project (QIP) at East Kent Neuropsychiatry Service. Year 4 medical students completed their first QIP cycle involving 4 students, 2 multidisciplinary team members and 4 patients with functional neurological presentations. An FND leaflet and symptom recording template was produced and reviewed using feedback domains such as leaflet readability, perceived usefulness, and template design. The revised version of leaflet was then pilot-tested in second QIP cycle via email or post to 12 patients awaiting their group psychology or neuropsychiatry appointments for treatment of FND. The uptake and impact of leaflet was assessed using telephone-based structured feedback collection.ResultThe first QIP cycle included 10 participants and generated qualitative knowledge domains, providing examples of different types of FND presentations and a biological-psychological-social model explaining onset and/or recurrence of FND symptoms. Group patient feedback and co-production input allowed inclusion of the patient voice and a re-design of leaflet and symptom recording template.The second QIP cycle involved 12 participants: feedback was collected two weeks after circulation of patient education material. Only 5 participants (42%) had read and used their education leaflet and template during this period. Patients described the booklet as useful overall, but thought it to be more useful at the point of diagnosis and referral to neuropsychiatry. Qualitatively, patients wished there to be more emphasis on FND being explained as “less psychiatric, more a neuropsychiatric problem”, and that it would be “very good for someone who had just been diagnosed”. 80% of responders rated the leaflet quality 8/10 or above. These respondents felt that the leaflet had helped them understand their condition better than they did previously. Usefulness of an additional self-formulation flowchart was rated as 8/10 or below by all patients - with several finding it difficult to use.ConclusionOur QIP supports the need for early patient education when discussing diagnosis of FND. The finding of 42% uptake within two weeks of leaflet dispatch is encouraging.
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Altunbey Ozbay, Feyza, and Bilal Alatas. "A Novel Approach for Detection of Fake News on Social Media Using Metaheuristic Optimization Algorithms." Elektronika ir Elektrotechnika 25, no. 4 (August 7, 2019): 62–67. http://dx.doi.org/10.5755/j01.eie.25.4.23972.
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Deceptive content is becoming increasingly dangerous, such as fake news created by social media users. Individuals and society have been affected negatively by the spread of low-quality news on social media. The fake and real news needs to be detected to eliminate the disadvantages of social media. This paper proposes a novel approach for fake news detection (FND) problem on social media. Applying this approach, FND problem has been considered as an optimization problem for the first time and two metaheuristic algorithms, the Grey Wolf Optimization (GWO) and Salp Swarm Optimization (SSO) have been adapted to the FND problem for the first time as well. The proposed FND approach consists of three stages. The first stage is data preprocessing. The second stage is adapting GWO and SSO for construction of a novel FND model. The last stage consists of using proposed FND model for testing. The proposed approach has been evaluated using three different real-world datasets. The results have been compared with seven supervised artificial intelligence algorithms. The results show GWO algorithm has the best performance in comparison with SSO algorithm and the other artificial intelligence algorithms. GWO seems to be efficiently used for solving different types of social media problems.
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Shivji, Dhiren, Panayiota Petrochilos, Michelle Balaratnam, Charlie Lane, Clare Nicholson, Isaiah See, Ali-Jesus Alim-Marvasti, Arvind Chandratheva, Robert Simister, and Salman Haider. "006 A novel approach in the management of functional neurological disorder in the hyper-acute setting." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 9 (August 12, 2022): e2.198. http://dx.doi.org/10.1136/jnnp-2022-abn2.50.
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IntroductionFunctional Neurological Disorder (FND) is common and can lead to multiple emergency department (ED) presentations and unnecessary investigation. Early identification and intervention have been shown to reduce health care costs and re-presentation to acute services by more than 50%1.We created a pilot model to provide early access to a multi-disciplinary FND team for patients assessed by the ED-embedded neurology team (Stroke or Neurology SDEC pathway) to have a new diagnosis of FND. The MDT provided patients with individualised information about FND, pathway navigation, and shown self-management tools.MethodsWe reviewed data for all patients seen to date by the pilot service.ResultsSince commencement in November 2021, nine patients have been seen by the MDT. All patients were seen within two weeks by a neurophysiotherapist and neuropsychiatrist with neurology support.6 were female and median age was 41 years. All presented with limb weakness and/or sensory distur- bance. 7 reported prior anxiety or depression. 6 had psychiatric factors, including Emotionally Unstable Personality Disorder and health anxiety. Follow up, 2 of the 9 patients so far demonstrated reduced health anxiety and increased confidence.ConclusionAn acute FND pathway can provide timely intervention and reduce symptoms for new presentations with FND.1. Stepped care for functional neurological disorder, A new approach to improving outcomes for a common neurological problem in Scotland. Report and Recommendations, NHS Improvement, February 2012
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Kumari, Shakuntala, B. K. Rai, R. Bhandari, S. N. Gupta, and K. Ahmed. "Computerized Tomography of the Brain for Elderly Patients Presenting to the Emergency Room with Acute Confusion State in Eastern Nepal." Journal of BP Koirala Institute of Health Sciences 1, no. 2 (December 21, 2018): 95–100. http://dx.doi.org/10.3126/jbpkihs.v1i2.22086.
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Background: Acute confusion is a common reason for presentation of elderly patients to the emergency which may be of neurological or non-neurological origin. Computerized tomography (CT) scans are often routinely ordered to investigate the cause.
Objective: To determine the usefulness of CT scan brain in confused elderly patients.
Methods: A cross-sectional observational study was conducted in emergency room (ER) of B. P. Koirala Institute of Health Sciences over a period of 6 months in 84 patients above the age of 65 years who had CT scan brain done in view of acute confusion. They were reviewed for symptoms, indications of CT scan and presence of focal neurological deficits (FND).
Results: Among patients presenting in confusion and with loss of consciousness or limb weakness, CT scan was abnormal in 90% and 92% cases respectively (p <0.05) whereas those presenting with fever, cough, headache, dizziness, seizure in confusion also had abnormal CT but was statistically not significant (p> 0.05). Out of 84 elderly cases of acute confusion, 52 had FND and the remaining 32 cases were without FND. Among those with FND, 40% and 46% cases had features of ischemic and hemorrhagic stroke respectively. Among the 32 without FND, 66% patients had normal scan and 38% had cerebral atrophy. In patients with Glasgow Coma Scale (GCS) < 9 with FND, 75% had CT scan suggestive of hemorrhagic stroke whereas those with GCS> 13 with FND, 57% and 29% cases had ischemic and hemorrhagic stroke respectively.
Conclusion: CT scan brain for confused elderly should be advised for those with focal neurological symptoms and may be suggested in cases of head trauma or alleged history of fall irrespective of GCS and symptomatology.
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Al-Yahya, Maha, Hend Al-Khalifa, Heyam Al-Baity, Duaa AlSaeed, and Amr Essam. "Arabic Fake News Detection: Comparative Study of Neural Networks and Transformer-Based Approaches." Complexity 2021 (April 16, 2021): 1–10. http://dx.doi.org/10.1155/2021/5516945.
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Fake news detection (FND) involves predicting the likelihood that a particular news article (news report, editorial, expose, etc.) is intentionally deceptive. Arabic FND started to receive more attention in the last decade, and many detection approaches demonstrated some ability to detect fake news on multiple datasets. However, most existing approaches do not consider recent advances in natural language processing, i.e., the use of neural networks and transformers. This paper presents a comprehensive comparative study of neural network and transformer-based language models used for Arabic FND. We examine the use of neural networks and transformer-based language models for Arabic FND and show their performance compared to each other. We also conduct an extensive analysis of the possible reasons for the difference in performance results obtained by different approaches. The results demonstrate that transformer-based models outperform the neural network-based solutions, which led to an increase in the F1 score from 0.83 (best neural network-based model, GRU) to 0.95 (best transformer-based model, QARiB), and it boosted the accuracy by 16% compared to the best in neural network-based solutions. Finally, we highlight the main gaps in Arabic FND research and suggest future research directions.
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González-Herrero, Belén, Francesca Morgante, Javier Pagonabarraga, Biba Stanton, and Mark J. Edwards. "Autism Spectrum Disorder May Be Highly Prevalent in People with Functional Neurological Disorders." Journal of Clinical Medicine 12, no. 1 (December 30, 2022): 299. http://dx.doi.org/10.3390/jcm12010299.
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Recent observations suggest that autism spectrum disorder (ASD) co-occurs in people with a functional neurological disorder (FND), but little systematic data are available on the relationship between FND and autism. The study aimed to assess the self-reported autistic traits via a standardized questionnaire and the prevalence of previously diagnosed ASD among people with FND and their 1st-degree relatives. We performed a survey of members of the patient organization FNDHope, using a self-completed questionnaire for screening for autistic traits and ASD: the adult autism subthreshold spectrum (AdAS spectrum). There were 344 respondents diagnosed with FND with a mean age of 39.8 ± 11.6 years (female sex 90%). Eight per cent of respondents volunteered a previous diagnosis of ASD, and 24% reported a 1st-degree relative with a formal diagnosis of ASD, mostly their children. We found that 69% of respondents had scores in the AdAS spectrum indicating a clinically significant ASD and 21% indicating autistic traits. Further studies are needed to provide more evidence regarding the prevalence of ASD in people with FND and how this may influence the aetiology, treatment selection and prognosis.
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Perjoc, Radu-Stefan, Eugenia Roza, Oana Aurelia Vladacenco, Daniel Mihai Teleanu, Roxana Neacsu, and Raluca Ioana Teleanu. "Functional Neurological Disorder–Old Problem New Perspective." International Journal of Environmental Research and Public Health 20, no. 2 (January 8, 2023): 1099. http://dx.doi.org/10.3390/ijerph20021099.
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Functional neurological disorder (FND) is a common issue in the pediatric population. The concept and our understanding of functional neurological disorders have changed over the past years, and new etiologic models and treatment plans have been explored. Knowledge about FND in the pediatric population, however, is lacking. The aim of this review is to provide an update on pediatric functional neurological disorder. We conducted a literature search of PubMed and SCOPUS databases and reviewed a total of 85 articles to gain insight into the current understanding of FND etiology, diagnosis, treatment, and prognosis in children and adolescents. Functional and high resolution MRI revealed abnormal connectivity and structural changes in patients with functional symptoms. The diagnostic criteria no longer require the presence of a psychological factor and instead focus on a rule-in diagnosis. Treatment of FND includes a clear communication of the diagnosis and the support of a multidisciplinary team. Although FND typically has a poor prognosis, better outcomes appear to have been achieved in children and young adults. We conclude that pediatric functional neurological disorder is a prevalent pathology and that this patient population has additional specific needs compared to the adult population.
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Wang, Qiying, Arina Udom, Yanxin Wang, Paulina Kusnierz-Was, Megan Castro, Matthew Butler, and Sotirios Posporelis. "#3106 Limb weakness in the emergency department: a focus on unexplained aetiology presentations." Journal of Neurology, Neurosurgery & Psychiatry 92, no. 8 (July 16, 2021): A16.2—A17. http://dx.doi.org/10.1136/jnnp-2021-bnpa.37.
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BackgroundFunctional neurological disorder (FND) is a common and potentially disabling neuropsychiatric condition. While its presentation can be extremely diverse, from aphonia to seizure activity, one of the most common symptoms is weakness of one or more limbs. Despite functional weakness being one of the most common presentations seen in neurological practice, little is known about its prevalence in an Emergency Department (ED) setting. Hereby, we aim to describe the demographic and clinical characteristics of patients attending the ED with limb weakness of an unknown and potentially functional aetiology.MethodsWe carried out a retrospective electronic records review of all ED attendances with limb weakness as the presenting complaint, at Kings College Hospital. Patients admitted to the hospital were followed up until the point of discharge. The following clinical and demographic data were analyzed: age, gender, mode of arrival, psychiatric history and clinical diagnosis on discharge. Results: During the 15-month study period, 1340 patients presented with leg weakness at the ED, nearly half of these (47.54%) arrived by ambulance. 4.55% had unexplained weakness with no definite diagnosis on discharge. A significant proportion (62.31%) were admitted for further investigations; 6.35% of these were diagnosed with FND, while a further 25 patients (2.99%) were discharged with suspected FND. Patients with an FND diagnosis had a median age of 45 years; 62.96% were females, and they were significantly younger than male patients with FND (P=0.003). Less than half (44%) of the FND patients had one or more psychiatric diagnoses.DiscussionA diagnosis of functional leg weakness was given to 3.95% (53/1340) of patients presenting with leg weakness in the ED. It is striking that none of these patients were given a diagnosis of FND in the ED, but only after admission to a ward. 6.4% (86/1340) were discharged from the hospital with an unclear diagnosis, 14% of which a functional overlay was suspected. Main limitations of the study: it is retrospective and single-centre.ConclusionThis study highlights difficulties and obstacles in recognising and diagnosing functional presentations of limb weakness in the ED. There is a clear need for optimisation of the classification and coding system of the Emergency Department. Increased awareness and education around FND has the potential to raise diagnostic confidence and significantly improve patient experience and care.
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Butler, Matthew, Mathieu Seynaeve, Susannah Pick, James Rucker, and Timothy Nicholson. "20 International online survey of 1162 individuals with functional neurological disorder: demographics, symptom comorbidities, self- management strategies, and illness beliefs." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 8 (July 20, 2020): e16.1-e16. http://dx.doi.org/10.1136/jnnp-2020-bnpa.37.
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AimsFunctional neurological disorder (FND) is common and often severe. It is poorly understood, and there have been no international large-scale studies of self- management and illness beliefs in FND. We created a patient questionnaire to assess FND demographics, symptom comorbidity, self-management strategies (particularly in relation to prohibited substances), views on novel treatments, and illness beliefs.MethodsThe questionnaire was shared open access over a three-week period.Participants were recruited internationally through social media and patient groups. RESULTS: In total, 1162 respondents from 16 countries took the survey. Of these, 98% reported a formal diagnosis of FND from a consultant neurologist or other suitably trained clinician. Females constituted 86% of respondents, with an average age of 41.7 years (SD=12.50). Mean symptom duration was 7.69 years (SD=9.37) and average time from diagnosis was 2.24 years (SD=3.35), indicating a diagnostic lag of over 5 years. Symptom comorbidity was very high, with respondents reporting current: seizures (50%), gait disturbance (76%), loss of balance (77%), tremors (61%), muscle jerks/spasms (65%), altered sensations (79%), speech difficulties (65%), memory problems (80%), fatigue (93%), and headache (70%). Current psychiatric comorbidities – depression (43%), anxiety (51%), panic (20%), and PTSD (22%) - were also common. Illness beliefs varied, with respondents agreeing most strongly that FND is a combination of physical and stress/trauma-related factors. Respondents rated FND as having a severe effect on their life, with little control felt over their symptoms. Respondents had received a wide range of medical interventions, and many had tried alternative treatments. Prohibited substances such as cannabis, ketamine, and psychedelics had been used by 15% of respondents, with the majority experiencing no or minimal physical (90%) and psychological (95%) sequelae. Many respondents reported that they would be willing to try medically supervised psychedelic therapy if it was found to be safe and effective.ConclusionsThis large international online survey of FND patients indicated a striking co-occurrence of multiple symptoms. As expected, respondents reported that FND severely impacted on their lives, and many had lived with symptoms, which are not well managed by current medical therapies, for years. There was interest in novel putative treatments, such as medically supervised psychedelic therapies, which indicates a strong need to investigate alternative treatments for this poorly served patient group.
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Diez, Ibai, Laura Ortiz-Terán, Benjamin Williams, Rozita Jalilianhasanpour, Juan Pablo Ospina, Bradford C. Dickerson, Matcheri S. Keshavan, W. Curt LaFrance Jr, Jorge Sepulcre, and David L. Perez. "Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder." Journal of Neurology, Neurosurgery & Psychiatry 90, no. 8 (March 8, 2019): 929–38. http://dx.doi.org/10.1136/jnnp-2018-319657.
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ObjectiveSome individuals with functional neurological disorder (FND) exhibit motor and affective disturbances, along with limbic hyper-reactivity and enhanced motor-limbic connectivity. Given that the multimodal integration network (insula, dorsal cingulate, temporoparietal junction (TPJ)) is implicated in convergent sensorimotor, affective and interoceptive processing, we hypothesised that patients with FND would exhibit altered motor and amygdalar resting-state propagation to this network. Patient-reported symptom severity and clinical outcome were also hypothesised to map onto multimodal integration areas.MethodsBetween-group differences in primary motor and amygdalar nuclei (laterobasal, centromedial) were examined using graph-theory stepwise functional connectivity (SFC) in 30 patients with motor FND compared with 30 healthy controls. Within-group analyses correlated functional propagation profiles with symptom severity and prospectively collected 6-month outcomes as measured by the Screening for Somatoform Symptoms Conversion Disorder subscale and Patient Health Questionnaire-15 composite score. Findings were clusterwise corrected for multiple comparisons.ResultsCompared with controls, patients with FND exhibited increased SFC from motor regions to the bilateral posterior insula, TPJ, middle cingulate cortex and putamen. From the right laterobasal amygdala, the FND cohort showed enhanced connectivity to the left anterior insula, periaqueductal grey and hypothalamus among other areas. In within-group analyses, symptom severity correlated with enhanced SFC from the left anterior insula to the right anterior insula and TPJ; increased SFC from the left centromedial amygdala to the right anterior insula correlated with clinical improvement. Within-group associations held controlling for depression, anxiety and antidepressant use.ConclusionsThese neuroimaging findings suggest potential candidate neurocircuit pathways in the pathophysiology of FND.
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Ampaw, Samuel, Edward Nketiah-Amponsah, and Bernardin Senadza. "Urban Farm-Nonfarm Diversification, Household Income and Food Expenditure in Ghana." Studies in Business and Economics 12, no. 2 (August 28, 2017): 6–19. http://dx.doi.org/10.1515/sbe-2017-0017.
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Abstract This paper investigates the impact of farm-nonfarm diversification (FND) on household income and food expenditure in urban Ghana using propensity score matching (PSM) technique to account for potential selection bias. We find diversified households to be statistically different from undiversified households in terms of household characteristics. Age, gender, educational attainment of the household head, household size, ownership of livestock and agricultural land, and receipt of miscellaneous and rent incomes are positive and significant determinants of FND in urban Ghana. In addition, we find that participation in both farm and nonfarm activities positively and significantly impacts household income and food expenditure. In the light of growing urbanization, with its implications for unemployment, poverty and food insecurity, we recommend diversification among urban households as a means of smoothing income and consumption.
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Raper, Joseph, Victoria Currigan, Sarah Fothergill, Jon Stone, and Rob J. Forsyth. "Long-term outcomes of functional neurological disorder in children." Archives of Disease in Childhood 104, no. 12 (July 20, 2019): 1155–60. http://dx.doi.org/10.1136/archdischild-2018-316519.
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ObjectivesTo establish the incidence and long-term outcomes (up to 21 years) of children presenting to a University hospital paediatric neurology service with symptoms due to functional neurological disorder (FND) with particular reference to occurrence of FND or similar symptoms in adulthood.MethodsRetrospective chart review to determine characteristics of the original paediatric FND presentation plus record-linkage with providers of Child and Adolescent Mental Health Services. Chart review of adult medical records for documentation of functional symptoms in adulthood.Results124 individuals (56% female) met entry criteria. The most common presentations were seizures (18%), sensory loss (18%) and motor symptoms (16%). Frequency gradually increased with age of onset with an incidence in paediatric neurological services of 6 per 100 000 children under 16. In up to 21 years’ follow-up (median 8.3 years), 114/124 attained their 16th birthdays by the study census date and were thus eligible for inclusion in an analysis of symptom persistence/recurrence in adulthood. 26/114 (23%) showed evidence of FND in adulthood of sufficient significance to be recorded in medical records.ConclusionPaediatric FND is commoner than previous estimates. Even in this selected population of children reaching specialist paediatric neurology services, a high long-term remission rate is observed.
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Cope, Sarah R. "EMDR as an Adjunctive Psychological Therapy for Patients With Functional Neurological Disorder: Illustrative Case Examples." Journal of EMDR Practice and Research 14, no. 2 (March 16, 2020): 76–89. http://dx.doi.org/10.1891/emdr-d-20-00008.
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Functional neurological disorder (FND) is a common diagnosis in neurology clinics, and there is some evidence psychological therapy can be of benefit. Eye movement desensitization and reprocessing therapy (EMDR) is a well-evidenced treatment for posttraumatic stress disorder (PTSD), and there is increasing evidence that it is beneficial for other conditions. EMDR is a therapy designed to focus on distressing memories, and therefore can be used for non-PTSD presentations where distressing memories are relevant. There is a small amount of case study evidence that EMDR can be used successfully with FND presentations and comorbid PTSD. This article describes two illustrative case examples of people diagnosed with FND who have distressing memories relevant to their presentation. Presenting functional symptoms included functional non-epileptic attacks and functional sensory symptoms. Psychological treatment-as-usual plus EMDR resulted in improvements for both cases and demonstrated that EMDR is a promising additional treatment option for FND presentations, appropriately selected. Recommendations regarding further research are made.
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Larner, Andrew J. "Functional Cognitive Disorders (FCD): How Is Metacognition Involved?" Brain Sciences 11, no. 8 (August 18, 2021): 1082. http://dx.doi.org/10.3390/brainsci11081082.
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Functional cognitive disorders (FCD) have become a subject of increasing clinical interest in recent years, in part because of their high prevalence amongst patients attending dedicated memory clinics. Empirical understanding of FCD based on observational studies is growing, suggesting a relationship to other functional neurological disorders (FND) based on shared phenomenology. However, understanding of FCD at the theoretical level has been lacking. One suggestion has been that FCD are disorders of metacognition, most usually of metamemory. In this article, a brief overview of these constructs is presented along with existing evidence for their impairment in FCD. Previous adaptations of theoretical models of FND to accommodate FCD are reviewed. A novel application to FCD of Nelson and Narens’ monitoring and control model of metamemory is then attempted, positing an improper setting of the monitoring function, with examples of ecological relevance. Formulation of FCD in light of a metacognitive model of anosognosia is also considered. Although lacking mechanistic and neuroanatomical sophistication, this metacognitive formulation of FCD may give pointers for future hypothesis-driven research and a pragmatic basis for management strategies.
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Gavilán, Javier, César Gavilán, and Jesús Herranz. "Functional Neck Dissection: Three Decades of Controversy." Annals of Otology, Rhinology & Laryngology 101, no. 4 (April 1992): 339–41. http://dx.doi.org/10.1177/000348949210100409.
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Functional neck dissection (FND) is a neck-functional, tumor-radical approach for the management of the neck in patients with head and neck cancer. Based on the anatomic knowledge of the lymphatic compartments of the neck, FND is a different surgical technique rather than a modification of the classic procedure described by Crile. From an oncologic viewpoint, FND is a relatively safe operation to treat the cervical spread from head and neck cancer as long as the indications and technical details are carefully followed. In this report, based on our experience with more than 1,000 FNDs, we analyze the history and the philosophy of the operation.
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Houston, James, and Paul Cooper. "169 An audit into the management of functional neurological disorder in Salford." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 9 (August 12, 2022): e2.128. http://dx.doi.org/10.1136/jnnp-2022-abn2.213.
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BackgroundFunctional neurological disorder (FND) is a debilitating condition impacting all aspects of life. Poor understanding of FND, and lack of clinical service pathways, may result in poor management, compared to recent NICE (2021) Quality Standards. We audited patients diagnosed with FND after admission to Salford Royal, including the care pathways used.MethodsSalford Royal electronic patient records were accessed to populate an existing data collection tool used for analysis of neurological services. Patients admitted over a 4 month period were identified using ICD-10 coding (F44.5), with appropriate inclusion and exclusion criteria. We excluded patients with non-epileptic seizures as their prime diagnosis.ResultsWe identified 64 admitted patients, with 10 excluded. Of 54 patients analysed, 91% had a motor deficit, 53% had a sensory deficit, many therefore presenting with functional motor disorders, often with impaired mobility, and likely to benefit from a multidisciplinary team approach. 44% of patients had no documented management plan for their FND at discharge, and in 80% of patients follow-up plans were unclear. (It is acknowledged that limited access to outpatient letters from community services may have impacted results.)ConclusionFND patients are being failed by our services, which are not meeting NICE Quality Standards. The unit is currently developing a multidisciplinary service for FND patients, which has proved challenging in the present climate. We plan to repeat the audit once our proposed service is established.
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Cope, Sarah R., Lucy Mountford, Jared G. Smith, and Niruj Agrawal. "EMDR to Treat Functional Neurological Disorder: A Review." Journal of EMDR Practice and Research 12, no. 3 (August 2018): 118–32. http://dx.doi.org/10.1891/1933-3196.12.3.118.
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Eye movement desensitization and reprocessing (EMDR) therapy is an established treatment for posttraumatic stress disorder (PTSD), but there is increasing evidence for its use beyond PTSD. EMDR can be effective at treating distressing memories not associated with PTSD, as well as somatic symptoms (like chronic pain), and as such could potentially be used as a treatment for patients with functional neurological disorder (FND). Searches were conducted for published peer-reviewed articles on the use of EMDR for FND. The databases selected and searched were Medline, Embase, Cochrane Library, CINAHL Plus, Web of Science, PsychINFO, PubMed, and Francine Shapiro Library. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three relevant articles were found. The studies included are one case series and two case studies. Of the five participants included in the studies, four experienced functional non-epileptic attacks; and one experienced functional movement disorder. Four out of the five patients were successfully treated with EMDR. EMDR is potentially a useful treatment of FND, but further research, including controlled trials, is required. The authors propose that EMDR could be useful in treating patients with FND and comorbid PTSD, as well as patients without comorbid PTSD. We discuss the clinical implications and propose how EMDR could fit into the FND treatment pathway.