What does 'functional overlay' mean?

[210272]

And why do any neuros or GPs write this in our notes?

[christopher_cms]

what are your symptoms and what is your diagnosis ... need a lot more info to respond ... tks

[210272 in reply to christopher_cms]

I don't have 'FND' I was just curious about what this community think 'functional overlay' means.

[Gypsi]

Since no one better qualified has so far ventured a reply, let me do so. I would guess this means there are certain indications or a suspicion/ conviction on the part of the said medical experts that some or all of the symptoms are not organic but rather functional, in which case a different treatment route would be applicable than were the illness organic, i. e. detectable by standard tests.

[Hidden in reply to Gypsi]

I’m qualified to explain as have been diagnosed with “FO/ FND”. The “functional” overlay is the same for neurologists as Fibromyalgia is to rheumatologists and IBS is to gastroenterologists. So each specialism has their own term for what they consider to be non-structural overlay rather than a new or progressing pathology.

The trouble is that when any of these conditions I’ve mentioned above, are diagnosed in the context of other underlying conditions - especially those that are rare and complex - the chances are that the specialists who diagnose overlaying FND, Fibromyalgia or IBS (good doctors don’t in my experience) have not the first clue how to know whether the underlying disease process is active or not. So they should always work with the other specialists to take a MDT approach before deciding - if they have to decide and if it really is in their patient’s best interest - not just their own. My neurologist tried to find out how active my Sjögren’s was but unfortunately the general rheumatologist also doesn’t have a clue about my rare rheumatic disease nor has she recognised the overlapping rare diseases, having only seen me briefly twice in 3 years.

I had to go down to the south of England to see a real specialist and pay for her overview to be able to return to my neurologist with answers that will hopefully get shot of “functional” overlay finally and forever.

So decisions on what’s “functional” always need to be viewed in a much broader scenario than just in the context of neurological diseases such as MS and PD. And of course they aren’t and won’t ever be, however much we might wish it to be so. Therefore “functional overlay” will always be a potentially dangerous diagnosis, risking missing overlap rather than overlay.

And I’m so hoping that one day very soon these various specialists, particularly rheumatologists and neurologists, will start to realise this and stick to excluding diseases which lie in their own specialist area rather than straying into psychology and reinventing Freud. If a consultant neurologist can’t find any sign of their own diseases then just have the guts to say so and let the patient and their GP pursue these new overlaying or overlapping symptoms elsewhere.