Functional Neurological Disorder
For the field of functional neurological disorder (FND), a sentiment of renewal and progress abounds. Historically neglected by neurology and psychiatry,1 and at times wrongly confused with malingering,2 the field of FND is now rapidly growing and helping to close the gap between two specialties for the same organ (ie, the brain).3 The transformations and progress in the field of FND have been catalyzed by a diagnostic approach emphasizing rule-in signs and semiologic features that are specific for the diagnosis. (Source: Neurologic Clinics)
Source: Neurologic Clinics - May 29, 2023 Category: Neurology Authors: David L. Perez, Sara A. Finkelstein Tags: Preface Source Type: research
Futility and Shared Decision-Making
Medical futility is an ancient and yet consistent challenge in clinical medicine. The means of balancing conflicting priorities and stakeholders ’ preferences has changed as much as the science that powers the understanding and treatment of disease. The introduction of patient self-determination and choice in medical decision-making shifted the locus of power in the physician–patient relationship but did not obviate the physician’s res ponsibilities to provide benefit and prevent harm. As we have refined the process in time, new paradigms, specialists, and tools have been developed to help navigate the ever-changing ...
Source: Neurologic Clinics - May 23, 2023 Category: Neurology Authors: Michael A. Rubin, Jenny Riecke, Elizabeth Heitman Source Type: research
Global Neurology
Global health programs engaging in isolated or short-term medical missions can and do cause harm, reinforce health care disparities, and impede medical care in the regions where it is so desperately needed. Related ethical, medical, and legal concerns are reviewed in this article. The authors recommend abandoning these ill-considered missions and focusing attention and resources on advancing neurology through ethically congruent, multisectoral, collaborative partnerships to establish sustainable, self-sufficient training programs within low- and middle-income countries. (Source: Neurologic Clinics)
Source: Neurologic Clinics - May 23, 2023 Category: Neurology Authors: James C. Johnston, Thomas P. Sartwelle, Mehila Zebenigus, Berna Arda, Roy G. Beran Source Type: research
Functional Neurological Disorder: Diagnostic Pitfalls and Differential Diagnostic Considerations
Functional neurologic disorder (FND) is a “rule-in” diagnosis, characterized by positive examination signs or semiological features. Similar to other clinical diagnoses, providers should ideally see robustly present features, including if possible the identification of multiple features consistent with FND for the diagnosis to be made w ith a high degree of certainty. Diagnostic pitfalls need to be guarded against and vary depending on FND symptom subtype and the specific patient presentation. This perspective article aims to review pitfalls based on an FND symptom subtype, as well as discuss differential diagnostic co...
Source: Neurologic Clinics - May 22, 2023 Category: Neurology Authors: Sara A. Finkelstein, Stoyan Popkirov Source Type: research
Functional Neurological Disorder
Functional neurologic disorder (FND) is a “rule-in” diagnosis, characterized by positive examination signs or semiological features. Similar to other clinical diagnoses, providers should ideally see robustly present features, including if possible the identification of multiple features consistent with FND for the diagnosis to be made w ith a high degree of certainty. Diagnostic pitfalls need to be guarded against and vary depending on FND symptom subtype and the specific patient presentation. This perspective article aims to review pitfalls based on an FND symptom subtype, as well as discuss differential diagnostic co...
Source: Neurologic Clinics - May 22, 2023 Category: Neurology Authors: Sara A. Finkelstein, Stoyan Popkirov Source Type: research
False Claims Act and Anti-Kickback Statute
Health care entities doing business with the federal government may run afoul of the False Claims Act and Anti-Kickback Statute not only when they directly submit fraudulent claims for government reimbursement but also when they create schemes that manipulate others into submitting (whether knowingly or unknowingly) illegal claims. In recent years, the Department of Justice is deploying these statutes to ensure that electronic health records are built and maintained with appropriate cybersecurity protections. (Source: Neurologic Clinics)
Source: Neurologic Clinics - May 20, 2023 Category: Neurology Authors: Rachel V. Rose, Joseph S. Kass Source Type: research
Functional Neurological Disorder Among Sexual and Gender Minority People
Sexual and gender minority (SGM) people can face unique stressors and structural discrimination that result in higher rates of neuropsychiatric symptoms, such as depression, anxiety, and suicidality. Although more rigorous studies are needed, emerging data suggest a possible higher prevalence of functional neurological disorder and other brain-mind-body conditions in SGM people. Representation and iterative feedback from affected community members is critical to the process of developing affirming environments. More research is needed to explore the relevance of functional neurologic disorder in SGM people within a biopsyc...
Source: Neurologic Clinics - April 21, 2023 Category: Neurology Authors: Mackenzie P. Lerario, Nicole Rosendale, Jeff L. Waugh, Jack Turban, Tina Maschi Source Type: research
Lessons from a Neurologist After 25 Years of Functional Neurological Disorder Subspeciality Practice
The idea that a neurologist would do an ‘FND clinic’ or that functional neurological disorder (FND) could be a subspecialty of neurology would have been outlandish even 20 years ago but has become a reality in many places around the world. In this personal review, I reflect on 25 years of being a neurologist with an interest in FND, initially as a research fellow and later as a consultant/attending. I review lessons from diagnosis and management in the hope that they may assist other neurologists embarking on a similar career as well as other health professionals whose roles overlap. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 20, 2023 Category: Neurology Authors: Jon Stone Source Type: research
Functional Movement Disorder
Functional movement disorder (FMD) is a common, potentially reversible source of disability in neurology. Over the last two decades, there have been major advances in our understanding of the clinical picture, diagnosis, and management of this condition. Motor presentation is heterogeneous and several non-motor symptoms (e.g., pain, fatigue) are part of the clinical spectrum. The diagnosis should be made by neurologists or neuropsychiatrists based on the presence of positive signs of inconsistency and incongruence with neurological diseases. Promising evidence has accumulated for the efficacy of physiotherapy, psychotherap...
Source: Neurologic Clinics - April 20, 2023 Category: Neurology Authors: Tereza Serranov á, Ilaria Di Vico, Michele Tinazzi Source Type: research
Using Verbally-Reported and Video-Observed Semiology to Identify Functional Seizures
Diagnosis of functional seizures, also known as psychogenic nonepileptic seizures, starts with a clinical interview and description of the seizures. A targeted approach to this evaluation can provide valuable information to gauge the likelihood of functional seizures as compared with other similar conditions including but not limited to epileptic seizures. This review focuses on the use of patient and witness descriptions and seizure videos to identify patients with probable functional seizures. Particular emphasis is given to recognizing the limitations of the available data and the influence of health-care provider exper...
Source: Neurologic Clinics - April 20, 2023 Category: Neurology Authors: Wesley T. Kerr Source Type: research
Functional Speech and Voice Disorders
Historically, formal training for speech-language therapists (SLTs) in the area of functional speech and voice disorders (FSVD) has been limited, as has the body of empirical research in this content area. Recent efforts in the field have codified expert opinions on best practices for diagnosing and treating FSVD and have begun to demonstrate positive treatment outcomes. To provide comprehensive interventions for these complex conditions at the intersection of neurology, psychiatry, and other medical specialties, the SLT must not only build knowledge of diagnostic strategies and components of symptomatic treatment in FSVD ...
Source: Neurologic Clinics - April 20, 2023 Category: Neurology Authors: Jennifer L. Freeburn, Janet Baker Source Type: research
Outpatient Approach to Occupational Therapy for Paroxysmal Functional Neurologic Symptoms
This article aims to describe in detail the goals and treatment strategies for occupational therapists to replicate this approach. This article is also an important first step in aiding the development and execution of clinical trials to further evaluate the effectiveness of sensory-based treatment in patients with FND. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 20, 2023 Category: Neurology Authors: Jessica Ranford, Julie MacLean Source Type: research
Somatic Symptom Disorder and Health Anxiety
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Somatic Symptom Disorder (SSD) and Illness Anxiety Disorder (IAD) replaced the diagnostic entities of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) somatoform disorders and hypochondriasis. SSD turns away from specifying the presence or absence of a medical condition for presented symptoms and instead focuses on excessive symptom-related affects, cognitions, and behaviors. People with pathological health anxiety can be diagnosed with SSD or IAD, depending on the intensity of accompanying somatic...
Source: Neurologic Clinics - April 20, 2023 Category: Neurology Authors: Karoline S. Sauer, Michael Witth öft, Winfried Rief Source Type: research
Informed Consent and Decision-Making for Patients with Acquired Cognitive Impairment
Informed consent (IC) is an ethical and legal requirement grounded in the principle of autonomy. Cognitive impairment may often interfere with decision-making capacity necessitating alternative models of ethically sound deliberation. In cases where the patient lacks decision-making capacity, one must determine the appropriate decision-maker and the criteria used in making a medical decision appropriate for the patient. In this article, I critically discuss the traditional approaches of IC, advance directives, substituted judgment, and best interests. A further suggestion is that thinking about sufficient reasons for or aga...
Source: Neurologic Clinics - April 20, 2023 Category: Neurology Authors: Christos Lazaridis Source Type: research
Medical Assistance in Dying in Neurology
An increasing number of jurisdictions have legalized medical assistance in dying (MAID) with significant variation in the procedures and eligibility criteria used. In the United States, MAID is available for persons with terminal illnesses but is frequently sought by persons with neurologic conditions. Persons with conditions that cause cognitive impairment, such as Alzheimer dementia, are often ineligible for MAID, as their illness is not considered terminal in its early stages, whereas in later stages, they may have impaired decision-making capacity. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 20, 2023 Category: Neurology Authors: Brent M. Kious Source Type: research
