Author response: Functional neurologic disorders: Bringing the informal and hidden curriculum to light
Laura A.Strom, Neurologist - Epileptologist, University of Colorado
Submitted January 22, 2020
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, is a diagnosis that many providers are loathe to give. Whether that is due to 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 non-judgmental and open-minded fashion. It took 30 years to add Functional Neurological Disorder to the DSM 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.
1. Strom LA. Functional neurologic disorders: Bringing the informal and hidden curriculum to light. Neurol Clin Pract Dec 2019, 10.1212/CPJ.0000000000000797; DOI: 10.1212/CPJ.0000000000000797.
2. Perez DL, Hunt A, Sharma N, Flaherty A, Caplan D, Schmahmann JD. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurology: Clinical Practice. 2019:10.1212/CPJ.0000000000000779.
3. Kanaan RAA. Freud's hysteria and its legacy. In: Hallett M, stone J, Carson A, eds. Handb Clin Neurol. Vol 139. 2016/10/11 ed.2016:37-44.
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, is a diagnosis that many providers are loathe to give. Whether that is due to 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 non-judgmental and open-minded fashion. It took 30 years to add Functional Neurological Disorder to the DSM 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.
1. Strom LA. Functional neurologic disorders: Bringing the informal and hidden curriculum to light. Neurol Clin Pract Dec 2019, 10.1212/CPJ.0000000000000797; DOI: 10.1212/CPJ.0000000000000797.
2. Perez DL, Hunt A, Sharma N, Flaherty A, Caplan D, Schmahmann JD. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurology: Clinical Practice. 2019:10.1212/CPJ.0000000000000779.
3. Kanaan RAA. Freud's hysteria and its legacy. In: Hallett M, stone J, Carson A, eds. Handb Clin Neurol. Vol 139. 2016/10/11 ed.2016:37-44.
For disclosures, please contact the editorial office at ncpjournal@neurology.org.