Quick reminder/notification about thi... - Functional Neurol...
Quick reminder/notification about this publication in the BMJ - as ever, I'd welcome your thoughts.
I thought this was a really helpful paper in describing positive ways of identifying fnd. Reading through the motor symptoms I realised that I could tick many of them. Had there been a tick sheet of the wide range of symptoms when I first presented, or indeed when I was first diagnosed years later with a positive hoover sign, it would have given me more confidence in the diagnosis seeing so many seemingly unrelated symptoms being ticked off.
While the article discusses the movement towards less stigmatizing language, there is still the problem that the everyday understanding of 'functional' is very different from the medical world, where I think the term 'functional' is still, unfortunately, equated with 'made up'. Sometimes I think neurologists working in the field hide behind the functional tag, while still being firmly attached to the view that seizures are purely psychological in cause, relying on patients thinking functional is something mechanical and so avoiding having to tell patients that they think they have, in essence, a mental health disorder. Why is there no hypothesis put forward to explain the equivalently higher than normal mortality rate for those people with seizures as experienced by people with epilepsy? Certainly there is an effect of the stress hormone cortisol but there doesn't appear to be any research aimed at understanding why it has such a marked impact in the people with seizures. And what about the role of inflammation? And also that an EEG doesn't pick up all epilepsy. There is still a long way to go in truly understanding what is happening. The term functional still leaves us in the grip of Charcot's and Freud's hysteria.
You might find this interesting: dx.doi.org/10.1136/jnnp-201...
If the link doesn't go live here, google 'the function of 'functional' a mixed methods review'
Thanks for this. My suspicions were not 'all in my head' - which on one level is very sad: to know that the attitude of 'doctor knows best' is still alive and very much kicking in the UK. There needs to be a clear break from the language and concepts of Charcot and Freud and the current medical leaders in the field are not doing that. I suspect that those with reputations built on allegedly bringing FND into the 21st Century will be very slow to accept any challenge. I worry that research is framed with confirmation bias and who is really challenging the research results, especially if researchers have close alliances with patient groups.
