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Diagnosing functional neurological disorder: seeing the whole picture

Published online by Cambridge University Press:  09 November 2020

Sarah C. Lidstone Open the ORCID record for Sarah C. Lidstone [Opens in a new window] ,
Walid Nassif ,
Jorge Juncos ,
Stewart A. Factor  and
Anthony E. Lang
Sarah C. Lidstone*
Affiliation:
Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
Walid Nassif
Affiliation:
Department of Psychiatry, Emory University, and the Veterans Affairs Medical Center, Atlanta, Georgia, USA
Jorge Juncos
Affiliation:
Department of Neurology, Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Emory University, Atlanta, Georgia, USA
Stewart A. Factor
Affiliation:
Department of Neurology, Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Emory University, Atlanta, Georgia, USA
Anthony E. Lang
Affiliation:
Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
*
*Author for correspondence: Sarah C. Lidstone, Email: sarah.lidstone@uhnresearch.ca
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Abstract

Functional neurological disorder (FND) is a complex neuropsychiatric syndrome with many phenotypes that are commonly encountered in clinical practice. Despite the heterogeneity of FND, the rate of misidentification is consistently low. For the more common motor subtypes, there are clear positive clinical, electrophysiological, and rarely imaging criteria that can establish the diagnosis in the traditional sense. For nonmotor subtypes, the characterization may be less clear. Here, we argue that the current diagnostic criteria are not reflective of the current shared neuropsychiatric understanding of FND, and, as a result, provide an incomplete picture of the diagnosis. We propose a three-step diagnostic triad for FND, in which the traditional neurological diagnosis is only the first element. Other steps include psychiatric/psychological formulation, integration, and follow-up. We advocate that this diagnostic approach should be the shared responsibility of neurology and mental health professionals. Finally, a research agenda is proposed to address the missing factors in the field.

Keywords

Diagnosisfunctional movement disorderfunctional neurological disorderpositive signspsychogenic movement disorderpsychogenic nonepileptic seizures
Type
Review
Information
CNS Spectrums , Volume 26 , Issue 6: Special Issue: Functional Neurological Disorder , December 2021 , pp. 593 - 600
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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