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April 2020; 10 (2) The Nerve! Readers Speak

Author response: Functional neurologic disorders: Bringing the informal and hidden curriculum to light

Laura A. Strom
First published April 6, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000000819
Laura A. Strom
(Boulder, CO)
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Author response: Functional neurologic disorders: Bringing the informal and hidden curriculum to light
Laura A. Strom
Neurol Clin Pract Apr 2020, 10 (2) 91; DOI: 10.1212/CPJ.0000000000000819

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Dr. Sethi raises an excellent point about the term functional neurologic disorder (FND) in his comment on the editorial.1 It seems clear that reticence to use the term functional creates the ambiguity he mentions. Medically unexplained symptoms, categorized in the international classification of diseases as undifferentiated somatoform disorders, are a diagnosis that many providers are loathed to give. Whether that is because of concern about missing a diagnosis is not clear. Having evaluated and treated more than 400 of these individuals in the FND clinic at the University of Colorado, I can attest to the fact that patients arrive confused about their diagnosis. Multiple incorrect diagnoses, as Dr. Sethi points out, pack the medical histories of patients with FND, leading doctors and patients astray. I believe that the commentary by Perez et al.2 gives us the best chance for a way forward, by teaching a new generation of residents and fellows how to approach patients in a nonjudgmental and open-minded fashion. It took 30 years to add Functional Neurologic Disorder to the Diagnostic and Statistical Manual, and it is still parenthetical to the term Conversion.3 Stripping the diagnosis of FND of its stigma and empowering care providers to rule in functional disorders is an actionable step which should be taken.

Footnotes

  • Author disclosures are available upon request (ncpjournal{at}neurology.org)

  • See letter

  • © 2020 American Academy of Neurology

References

  1. 1.↵
    1. Strom LA
    . Functional neurologic disorders: Bringing the informal and hidden curriculum to light. Neurol Clin Pract Epub 19 Dec 2019.
  2. 2.↵
    1. Perez DL,
    2. Hunt A,
    3. Sharma N,
    4. Flaherty A,
    5. Caplan D,
    6. Schmahmann JD
    . Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract Epub 4 Dec 2019.
  3. 3.↵
    1. Kanaan RAA
    . Freud's hysteria and its legacy. Handb Clin Neurol 2016;139:37–44.
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