A Historical Perspective on Functional Neurological Disorder

Kanaan, Richard A A

doi:10.1007/978-3-030-86495-8_1

Cited by 1 publication

(1 citation statement)

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“…The adaptive use of dissimulation and deception can develop very early before explicit cognitive processes arise, which makes differential diagnosis even more complex. These difficulties probably contribute to relatively low rates of factitious disorders in neurology settings (Kanaan, 2022;Kanaan & Wessely, 2010). For this reason, it is essential to involve different specialists in the assessment of children and adolescents with neurological symptoms, given that the interaction between biological, psychological, and social factors should always be considered (Hallett et al, 2022;Onofrj et al, 2023).…”

Section: Fnsd and Psychiatric Differential Diagnosesmentioning

confidence: 99%

Misdiagnosis of functional neurological symptom disorders in paediatrics: Narrative review and relevant case report

Baglioni,

Esposito,

Bernardi

et al. 2024

Clin Child Psychol Psychiatry

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Functional neurological symptom disorders (FNSD) pose a common challenge in clinical practice, particularly in pediatric cases where the clinical phenotypes can be intricate and easily confused with structural disturbances. The frequent coexistence of FNSDs with other medical disorders often results in misdiagnosis. In this review, we highlight the distinctions between FNSD and various psychiatric and neurological conditions. Contrary to the misconception that FNSD is a diagnosis of exclusion, we underscore its nature as a diagnosis of inclusion, contingent upon recognizing specific clinical features. However, our focus is on a critical learning point illustrated by the case of a 14-year-old male initially diagnosed with FNSD, but subsequently found to have a rare primary monogenic movement disorder (paroxysmal kinesigenic dyskinesia, PKD). The crucial takeaway from this case is the importance of avoiding an FNSD diagnosis based solely on psychiatric comorbidity and suppressible symptoms. Instead, clinicians should diligently assess for specific features indicative of FNSD, which were absent in this case. This emphasizes the importance of making a diagnosis of inclusion. Extended follow-up and clinical-oriented genetic testing might help identify comorbidities, prevent misdiagnosis, and guide interventions in complex cases, which cannot be simply classified as “functional” solely because other conditions can be excluded.

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