Overall comorbidities in functional neurological disorder: A narrative review

Carle-Toulemonde, Guilhem; Goutte, Julie; Do-Quang-Cantagrel, Nathalie; Mouchabac, Stéphane; Joly, Charlotte; Garcin, Béatrice

doi:10.1016/j.encep.2023.06.004

Cited by 17 publications

(5 citation statements)

References 105 publications

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“…The FND group also reported a greater number of daily events than HCs (encompassing stressful, pleasant, and stressful/pleasant events). These findings are consistent with our hypotheses and other studies that utilising retrospective self-report questionnaires (Brown & Reuber, 2016;Campbell et al, 2022;Carle-Toulemonde et al, 2023;Forejtova et al, 2023;Goldstein & Mellers, 2006;Pick et al, 2017). These results also accord with questionnaire data and laboratory-based measures obtained with this sample (Millman et al, 2024;Pick et al, 2023).…”

Section: Week-level Between-group Differencessupporting

confidence: 94%

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Real-time antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

Pick,

Millman,

Hodsoll

et al. 2024

Preprint

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Remote monitoring technologies (RMT) could provide critical insights into the mechanisms underlying functional neurological symptoms (FNS). We examined the feasibility and acceptability of a novel RMT protocol, aiming to identify psychobiological correlates and antecedents of FNS in everyday life. Seventeen individuals with FNS (seizures/motor) and 17 healthy controls (HC) completed ecological momentary assessments (EMA) eight times daily for 1-week, reporting FNS severity, associated physical and psychological symptoms, and subjectively significant events. Sleep quality was reported daily. Fitbit Charge 5s measured objective physiological variables. Multilevel modelling examined variables associated with FNS variability. EMA completion rates were high (≥80%). At week-level, the FNS group reported significantly elevated subjective arousal, pain, fatigue, dissociation, negative affect, daily events, stressful events, and sleep duration, compared to HC. Objective sleep disturbance and duration, and resting heartrate, were also significantly greater in the FNS sample. FNS severity correlated significantly with daily events, affect, subjective arousal, pain, fatigue and sleep disturbance, at day- or within-day levels. Daily events and negative affect temporally predicted momentary FNS severity. RMTs are feasible and acceptable tools for investigation of FNS in real-world settings, revealing daily events and negative affect as possible triggers of FNS. Larger-scale, longer-term RMT studies are needed in FND.

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Section: Week-level Between-group Differencessupporting

confidence: 94%

“…• Elevated subjective ratings of pain, fatigue, and sleep disruption would be seen in the FND group compared to HCs (Carle-Toulemonde et al, 2023;Forejtova et al, 2023;Graham & Kyle, 2017;Mousa et al, 2021), and these physical symptoms would be correlated with FNS severity (Millman et al, 2024).…”

Section: Aims and Hypothesesmentioning

confidence: 99%

Real-time antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

Pick,

Millman,

Hodsoll

et al. 2024

Preprint

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“…FNSD is difficult to treat due to persistent/disabling symptoms (Ducroizet et al, 2023;Durrant et al, 2011;Gelauff et al, 2014Gelauff et al, , 2019, as well as frequent neuromedical and psychiatric comorbidities (Carle-Toulemonde et al, 2023;Jennum et al, 2019). Although poor outcomes in patients with FNSD are partially attributable to inherent symptom severity/heterogeneity, clinicians have also erred (Burke, 2019), as there have been significant problems arising from underrecognition and frequent misunderstandings about FNSD (Keynejad et al, 2017; Clinical identification of internal inconsistency, where a patient demonstrates impairment in a cognitive domain in some situations but not others (also known as contrasting function/dysfunction; Ball et al, 2020;Cabreira et al, 2023;McWhirter et al, 2020a).…”

Section: Iatrogenesismentioning

confidence: 99%

“…In contrast, in an integrated model, the patient initially undergoes a thorough neuropsychiatric assessment, which is then translated into a personalized intervention provided by a collaborative team, addressing physical/neurological (Nielsen et al, 2015), mental health (Oriuwa et al, 2022), and social/situational (LaFaver et al, 2021) concerns. To date, positive results have been found with integrated interventions (Jacob et al, 2018;Jimenez et al, 2019;Lidstone et al, 2020), although the role of neuropsychology has been largely neglected, in spite of the prominence of cognitive dysfunction across FNSD subtypes (Carle-Toulemonde et al, 2023;Jones et al, 2016;Teodoro et al, 2018). That is, neuropsychologists can contribute to an interdisciplinary FNSD team with a thorough biopsychosocial clinical formulation, cognitive assessment to characterize strengths and weaknesses, and cognitive rehabilitation targeting the most distressing and disabling symptoms.…”

Section: Advancements In Management and Treatmentmentioning

confidence: 99%

The role of neuropsychology in the care of patients with functional neurological symptom disorder

Van Patten,

Mordecai,

LaFrance

2024

J Int Neuropsychol Soc

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Objective: Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists. Methods: A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment. Results: Two primary areas of focus for this review are the following: (1) increasing neuropsychologists’ training in FNSDs, and (2) increasing neuropsychologists’ role in assessment and treatment of FNSD patients. Conclusions: Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.

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“…For instance, recently, a group of authors (Carle-Toulemonde et al, 2023) provided a narrative review that highlighted several comorbidities associated with FNSD, including fatigue, cognitive symptoms, and psychiatric disorders (ranging from 40% to 100% of FNSD patients, with anxiety disorders being the most common). The presence of non-functional disorders, including neurological conditions like epilepsy in patients with FS (20%) and FMD in Parkinson's disease (7%), was also noteworthy.…”

Section: Fnsd Comorbiditiesmentioning

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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Overall comorbidities in functional neurological disorder: A narrative review

Cited by 17 publications

References 105 publications

Real-time antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

Real-time antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

The role of neuropsychology in the care of patients with functional neurological symptom disorder

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

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