Myths and

The Truth

Patients have either FND or another neurological disorder.

MYTH
No! FND is diagnosed by the presence of positive symptoms, such as Hoover's sign, where weakness in the hip extension returns to normal when attention is shifted to the opposite leg.

TRUTH

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A diagnosis of FND is made on the basis of excluding other neurological conditions.

MYTH
No! FND is often comorbid or co-occurs with other neurological conditions. Surgery, physical trauma and migraines are often triggering factors in vulnerable individuals, and up to 20% of patients with functional (dissociative) seizures are also diagnosed with epilepsy. Due to shared neurobiological mechanisms, FND often co-occurs with Parkinson's disease.

TRUTH

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FND is characterised by bizarre symptoms.

MYTH
No! FND is often equated with mysterious and clinically incomprehensible conditions, but the diagnosis should not be based on "bizarreness". The key to identifying FND lies in the variety of symptoms and signs, which vary according to the tasks and distraction techniques used. Also, in FND, movements are not bizarre but have 'rules of their own', which allows us to classify patients into typical subtypes of functional neurological disorder.

TRUTH

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Different FND subtypes represent different disorders.

MYTH
No (well, partly)! FND manifests itself in different ways in different patients. The functional symptoms are so varied and range from functional tremors, functional seizures, limb weakness dystonia, etc. Despite the diversity, they fall under the broader FND syndrome, and all FND subtypes share cognitive symptoms and pain and fatigue.

TRUTH

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FND patients simulate symptoms.

MYTH
No! Patients do not simulate symptoms, they are involuntary! Numerous neurophysiological studies and randomised trials in different cultures and time periods support FND as a specific clinical brain disorder and not as a consequence of patient simulation.

TRUTH

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Investigations play no role in the diagnosis of FND.

MYTH
No! Investigations can help diagnose additional neurological conditions, and laboratory results can be helpful in coping with difficult cases. Some investigations, such as tremor analysis, can help to make a positive diagnosis.

TRUTH

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If you misdiagnose a patient with a functional neurological disorder, you do less harm than if you misdiagnose them with another neurological disorder.

MYTH
No! Any misdiagnosis is worrying and stressful for the patient, especially when it comes to young or disabled individuals (especially when their condition is treatable). Misdiagnosing FND as another neurological disease can be as harmful as misdiagnosing another neurological disease as FND.

TRUTH

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FND is a purely psychological disorder, and the causes are always psychogenic in nature.

MYTH
No! Psychological factors play an important role, but they should not be confused with causes. This is also reflected in the DSM-5 diagnostic manual, which no longer requires the presence of a psychological stressor for diagnosis. FND FND is a complex and diverse disorder, with many biological, sociological and psychological mechanisms at work, which do not allow us to distinguish between mind and body. Thus, psychological factors are not relevant in all patients!

TRUTH

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The FND's prognosis is usually good.

MYTH
No! Unfortunately, there is a common misconception that there is nothing really wrong with FND patients and that their condition will improve with treatment. But studies show that the majority of FND patients remain the same or get worse after treatment. Due to a number of additional symptoms (fatigue, pain, cognitive impairment, psychiatric conditions), the quality of life of FND patients is severely impaired.

TRUTH

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FND is treated exclusively by a clinical (neuro) psychologist or psychiatrist.

MYTH
No! As with other neurological conditions, a multidisciplinary approach to treatment is essential! Patients with FND need individualised treatment, starting with a neurological examination and a detailed diagnosis. Studies show that for some patients (functional movement disorders) specialised physiotherapy alone is sufficient, while for others (e.g. functional dissociative seizures) psychological treatment is also important.

TRUTH

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Taken from:

Lidstone, S. C., Araújo, R., Stone, J., in Bloem, B. R. (2020). Ten myths about functional neurological disorder. European journal of neurology, 27(11), e62-e64. https://doi.org/10.1111/ene.14310

Myths and

The Truth

Patients have either FND or another neurological disorder.

A diagnosis of FND is made on the basis of excluding other neurological conditions.

FND is characterised by bizarre symptoms.

Different FND subtypes represent different disorders.

FND patients simulate symptoms.

Investigations play no role in the diagnosis of FND.

If you misdiagnose a patient with a functional neurological disorder, you do less harm than if you misdiagnose them with another neurological disorder.

FND is a purely psychological disorder, and the causes are always psychogenic in nature.

The FND's prognosis is usually good.

FND is treated exclusively by a clinical (neuro) psychologist or psychiatrist.

Taken from:

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