FUNCTIONAL NEUROLOGICAL DISORDER One of the most important diagnoses in neurology… is often missed because clinicians are looking too hard at the MRI and not hard enough at the EXAMINATION. A patient says: I cannot move my leg. But then: • Hoover sign appears • gait changes with distraction • tremor entrains • strength returns during automatic movement That is not nothing. That is a POSITIVE neurological pattern. Modern FND is no longer: “Diagnosis of exclusion.” It is a diagnosis of: ✅ inconsistency ✅ incongruence ✅ preserved automatic circuitry ✅ positive bedside signs The nervous system pathway exists. The brain is failing to ACCESS it normally. That single shift changes how you examine the patient. Hoover sign stops becoming a trick. It becomes a window into motor control. The patient CAN generate movement. But voluntary access becomes disrupted. And this is exactly why: • distraction may improve weakness • backward walking may normalize gait • tremor changes rhythm • functional seizures fluctuate dramatically FND sits at the intersection of: movement attention prediction emotion agency and motor control. The dangerous part? Patients are often harmed from BOTH sides. ⚠️ One clinician dismisses: Everything is psychological. ⚠️ Another escalates: benzodiazepines antiepileptics ICU admissions intubation Especially in functional seizures. Real expertise is knowing: when to stop escalating, without losing diagnostic vigilance. The best FND clinicians do 3 things well: 1️⃣ Rule out dangerous neurological disease carefully. 2️⃣ Rule IN FND positively. 3️⃣ Explain the diagnosis respectfully. Because the explanation itself becomes treatment. One sentence changes the entire consultation: 🧠 “Your nervous system pathways are still present. The problem is in how the brain is accessing control of them.” Not: “Nothing is wrong.” Modern FND management is not: “Reassure and discharge.” It is: • targeted physiotherapy • movement retraining • speech/swallow rehabilitation • psychiatric comorbidity management • nervous-system retraining FND is not anti-neurology. It IS neurology. And perhaps one of the purest examinations of how the brain converts intention into movement. #neurotwitter #Medtwitter #FND #Functionaldisorders

#FND #NeuroTwitter #Neurology #PNES #FunctionalDisorders #MedicalEducation #CBT #BrainFunctionNotDamage #PsychogenicSeizures #NeuroRehab #ClinicalNeuro #NeurologistsIndia #MedTwitterIndia #NeuroPearls 📚 References / Suggested Reading: Stone J, Carson A, Sharpe M. Functional neurological disorder: the neuropsychiatry of a ‘software’ problem. Lancet Neurol. 2020;19(4):292–302. Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of Functional Neurological Disorders. JAMA Neurol. 2018;75(9):1132–1141. American Psychiatric Association. DSM-5 Diagnostic Criteria for Conversion Disorder (FND). LaFaver K. Treatment of Functional Neurological Disorder: Current State and Future Directions. Continuum (Minneap Minn). 2021;27(5):1316–1330. Reuber M, Rawlings GH, Greater Manchester FND Service. Functional neurological disorders: an emerging health priority. BMJ. 2022;376:o64. Perez DL, LaFrance WC. Nonepileptic seizures: An updated review. CNS Spectrums. 2021;26(2):149–156. Nielsen G, Ricciardi L, Demartini B, et al. Physio-based rehabilitation for functional motor disorders. J Neurol Neurosurg Psychiatry. 2021;92:652–660. Sharma A, Pandey A, Agarwal P, et al. Psychogenic Nonepileptic Seizures: A Study from India. Seizure. 2013;22(10):812–816. Pick S, Goldstein LH, Perez DL, Nicholson TR. Psychogenic non-epileptic seizures: A neurocognitive perspective. Nat Rev Neurol. 2020;16(3):165–176. Aybek S, Perez DL. Diagnosis and Management of Functional Neurological Disorder. BMJ. 2022;376:o64. @nirmalregency @aditya_gan3500 @tweetingFaairy @drgunjand @abgohel @witchdrkochi

A brilliant presentation by @jonstoneneuro on Migraine & FND and what they can learn from each other. As two of the commonest conditions in Neurology, clearly there’s a lot - there’s also an overlap between #functionalseizures & other #functionaldisorders So a few things:

Worth sharing this again ... What happens to way too many people who find themselves on the 'red route'.. #MUS #Functionaldisorders etc...

Read the paper by Quigley et al "Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms" via bit.ly/47xdHgp @DipeshVasant #FunctionalDisorders

" it is apparent that previously healthy patients are [becoming seriously unwell after taking meds] “#asprescribed” – then dismissed/described as troublesome #heartsink pts who display “excessive” responses to distressing, chronic, #somaticsymptoms ..." #functionaldisorders

Read the paper by Quigley et al "Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms" via bit.ly/47xdHgp @DipeshVasant #FunctionalDisorders

Thank you @jchristawoodley. It seems that something is going on at Aarhus univesity .. have been watching for some years now how #effectsof #antidepressants etc are being re-classified as #functionaldisorders ... of #unknownaetiology ... researchgate.net/profile/Per…

Book 8 of 2023 #TheSleepingBeauties by @Suz_OSullivan. Really important read for vast majority doctors, you Will see functional disorders and this book may help to change your perspective on them. They are not malingering or factitious. #FunctionalDisorders @bedsidepodcast

"Is ‘#medicine’ actually causing a range of ‘#functional’ disorders'? This surely needs to be squarely addressed so that appropriate action can be taken to prevent further #harm to #patients – and indeed #doctors who are also patients." #MUS #FND #functionaldisorders #MedTwitter

8) gaslighting, blanket dismissals of their reality, & outright contempt for their illness & #disability. We must remember that #FunctionalDisorders & Munchausen's=RARE, not the norm. I believe we must start to heal that #trauma before we see positive strides. #BelievePatients

The conceptual field of medically unexplained symptoms and persistent somatic symptoms bit.ly/3i7H97V #functionaldisorders #FND #fndaware #fndawareness #functionalneurologicaldisorder #neuropsychiatry #rehabilitation #neurorehabilitation @CambridgeUP

Nova diretoria da Sociedade Brasileira de Motilidade Digestiva @SBMDN @luizjoaoabrahaojr novo Presidente #functionaldisorders

One week from Today. Looking forward to presenting my chapter. #SFT #booklaunch #BUP #funktionellelidelser #functionaldisorders

Para los que no creen en milagros, hoy entró una pte ciega con bastón a consulta. Salió viendo 20/20. #functionaldisorders

Michael Sharpe on the shortcommings of Body - mind dualism in modern medicine #EAPM #Functionaldisorders

Prof. Charlotte Ulrikka Rask sharing knowledge about #functionaldisorders at #MovingOnWithPain 🧐 #SMOF

5yrs since I first wrote to @BJGPjournal (2017) & 'thesis' still seen as 'too controversial'. 🤔?! Meanwhile '#FunctionalDisorders' are 'all the rage'. A deeply disturbing situation altogether. bjgp.org/content/69/681/163/…

#antidepressants'#anxietymeds "interfere with human functioning & lead to confusing debilitating #FunctionalDisorders. The current #GP #guidelines skim over meds as potential causes of #MUS. It appears that GPs & patients are actually being misled.."2017 welldoing.org/article/perils…

Indeed?! #MUS #medicallyunexplained #functionaldisorders … ? #phq15 From #Antidepressed by @T_A_Psupport - pages 72-73 & 76-77 (With thanks to @MooreMaz @jf_moore for Patient Journey design) penguinrandomhouse.com/books…