Functional neurology

[Healthinfo104]

Is functional neurology/ neurological disorders dealt with by physicians or by "neurological" chiropractors?

Everywhere I search about functional neurology only shows it being handled and treated by chiropractors.

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[typhoonegator]

They're two different things: treatment of neurology functional disorders, vs. chiropractic manipulation to treat neurologic disorders. One is science. One is not.

ChiroPro Performance Home Page - Functional Neurology and Rehabilitation

Focus on Functional Neurological Disorders

 

[neglect]

Focus on Functional Neurological Disorders

There is no longer any need to imagine hell. Move over, Hieronymus, you have been superseded.

 

[lobelsteve]

There is no longer any need to imagine hell. Move over, Hieronymus, you have been superseded.

Mass General Hysteria.

Dude is treating conversion d/o, somatoforms, and pure BS. But using BS to do so.
Not medical care. Shared delusions maybe.

 

[Spinothalamic]

Mass General Hysteria.

Dude is treating conversion d/o, somatoforms, and pure BS. But using BS to do so.
Not medical care. Shared delusions maybe.

So just to clarify, you are proposing that a “treatment plan that may involve physical therapy, cognitive behavioral therapy, or pharmacology, particularly if the patient is experiencing mood or anxiety symptoms” is not medical care and in fact completely worthless?

 

[lobelsteve]

So just to clarify, you are proposing that a “treatment plan that may involve physical therapy, cognitive behavioral therapy, or pharmacology, particularly if the patient is experiencing mood or anxiety symptoms” is not medical care and in fact completely worthless?

Nope, but this guy appears to buy into the fact that there is nothing wrong with these patients that is not psychiatric. Care should be from Psych, not Neuro.

 

[typhoonegator]

Nope, but this guy appears to buy into the fact that there is nothing wrong with these patients that is not psychiatric. Care should be from Psych, not Neuro.

The guy is a neuropsychiatrist. Maybe you should reach out to him if you're concerned.

 

[lobelsteve]

The guy is a neuropsychiatrist. Maybe you should reach out to him if you're concerned.

Would reach out to him, would not let my relatives see him either.

 

[neglect]

Mass General Hysteria.

Dude is treating conversion d/o, somatoforms, and pure BS. But using BS to do so.
Not medical care. Shared delusions maybe.

Nope, but this guy appears to buy into the fact that there is nothing wrong with these patients that is not psychiatric. Care should be from Psych, not Neuro.

Would reach out to him, would not let my relatives see him either.

I have no clue what you're saying here.

Although the patients are generally horrible, it takes a neurologist to diagnose them with functional disorders. A minority get the diagnosis, come to grips with their psychogenic nature, and work to benefit themselves. Again, this is a minority, but they all should be given this shot. So are you saying that there is no role for neurology? If so, then you're ignoring both the facts on the ground as well as tradition that dates back to Charcot.

Are you saying that neurologists should not treat psychiatric disorders? That we should not give SSRIs? Or offer counseling? Are you saying that conversion disorder is "pure BS" which is not appropriate to study or provide medical care? Do you not realize how disabling this condition can be? Have you actually seen anyone with chronic conversion disorder?

Do your relatives have functional problems? This helps explain your level of discourse.

 

[lobelsteve]

PMR trained. Functional disorders should include organic disease, maybe you are treating fictional disease instead?
All labs/imaging/history negative. Lets not spend healthcare dollars. And yes, turf to Psych for care.
Unsure about ad hominem attack, but my sister has a functional disorder. She is Peds Neuro and gets so little for her hard work.
Unsure if this qualifies to see Dr. Shrinker at Mass. She is Mito specialist.

 

[neglect]

PMR trained. Functional disorders should include organic disease, maybe you are treating fictional disease instead?
All labs/imaging/history negative. Lets not spend healthcare dollars. And yes, turf to Psych for care.
Unsure about ad hominem attack, but my sister has a functional disorder. She is Peds Neuro and gets so little for her hard work.
Unsure if this qualifies to see Dr. Shrinker at Mass. She is Mito specialist.

Again, I'm totally confused. Perhaps if you'd try to use sentences that relate and link to the next, so you form clear paragraphs, I'd have an easier time.

Functional disorders are NOT organic, as the word is traditionally understood. Organic disease, like stroke, gives rise to neurologic symptoms and signs. In these cases, there are neurologic s/s with no underlying pathology, with no lesions, and the presentations are not consistent with the way the nervous system works or becomes dysfunctional. For example, one might find a young person who cannot move her legs. This implies no strength in the legs. But when the legs are lifted, they stay in place, displaying very good strength against gravity. She will also have no bladder problems, inconsistent sensory exam, no changes in reflexes, and no trophic changes in legs. All labs and imaging will be negative.

But what do you mean by having a negative history? And why jump to "Let's not spend healthcare dollars"? This young person is highly disabled, and unlike her cousin who had transverse myelitis, there are no meds that can help her. So what would you do with her? If you are PMR trained, I can understand the frustration dealing with these folks. But that doesn't help either. Nor does "Truf to psych for care" because often times psychiatry will find nothing wrong with them. Because they have no insight, and disavow any symptoms of psychiatric problems or distress, they cannot be helped by psychiatry. Often times they resist psychiatry input and refuse to see them.

Can't comment on the rest as I tried to followed the above, admittedly not very well, but best luck to your sister.

 

[lobelsteve]

Got it. You feel smart.
mirror synesthesia - PubMed - NCBI
Impressive body of research on this.
Might as well lump it in with Morgellon's disease.

Kept sentences short for you.

 

[lobelsteve]

Patients with FND come to the clinic experiencing seizure-like events, abnormal movements, limb weakness and/or gait difficulties, yet traditional neurologic investigations don’t find a medical explanation for these symptoms. Doctors don’t see primary disruptions in motor brain pathways in these patients, nor do they uncover evidence of electrical seizures. Patients with these poorly understood functional neurological symptoms make up approximately 16 percent of referrals to neurology clinics.

 

[neglect]

Got it. You feel smart.

Feeling smarter than you does not entail feeling smart (or knowing or being smart). But yes.

Synesthesia has nothing to do with the functional neurologic problems, or is your thinking: functional disorders are weird and synesthesia is weird, so they must be related?

 

[lobelsteve]

This doctor can feel your pain - CNN

Home

Dept of Neurology at Mass Gen.

Looks like Dr. Perez runs the (dys)functional neuro program. But this awesome guy is also in the Neuro dept.

 

[Thama]

This doctor can feel your pain - CNN

Home

Dept of Neurology at Mass Gen.

Looks like Dr. Perez runs the (dys)functional neuro program. But this awesome guy is also in the Neuro dept.

This guy just spoke at AAN and the takeaway is that he doesn't see why neurologists shouldn't be psychiatrists too, as if we aren't already utterly inundated by patients with bonafide neurologic disorders. It was a frankly absurd discussion.

 

[neglect]

This doctor can feel your pain - CNN

Home

Dept of Neurology at Mass Gen.

Looks like Dr. Perez runs the (dys)functional neuro program. But this awesome guy is also in the Neuro dept.

Again, what are you talking about? Mass General has many neurologists. One runs a functional disorders program. One studies synesthesia and seems to have the same condition. I bet someone on staff studies Parkinson’s disease. But these disorders are not related.

This guy just spoke at AAN and the takeaway is that he doesn't see why neurologists shouldn't be psychiatrists too, as if we aren't already utterly inundated by patients with bonafide neurologic disorders. It was a frankly absurd discussion.

Sounds weird. What types of psych disorders does he recommend neurologists see and treat? We already have migraine - perhaps psych could take that one off our hands! And who cares what a neurologist wants to subspecialize in - just don’t tell me how to structure my practice.

 

[RenegadeSynapse]

It was the controversies plenary session. Dr. Perez argued neurologists should be primarily responsible for the management of FNDs. It'll be a subgroup of neurologists who do it / like it, but neither your typical community neurologist nor typical community psychiatrist is particularly well-equipped to manage chronic FNDs long-term. New symptoms crop up, and your average psychiatrist isn't going to feel comfortable determining whether it's a functional symptom or structural. A reasonable portion of neurologists are god-awful at dealing with the often (but not always) present psychiatric comorbidities. It's a challenging diagnosis to manage, and no one wants to do it. Good on those who are trying to bring evidence-based care to a neglected patient group. Dr. Perez is doing good work at MGH. Dr. LaFaver has an excellent program at Louisville that deals with functional movement / motor disorders that's had nice results with a brief inpatient rehab (5 days) stay.

Some more neuropsychiatrically-inclined behavioral neurologists, some (not all) movement trained neurologists, and neuropsychiatrists are probably the best group for these folks, but that group isn't large enough, and the patient population is far too common.

 

[neglect]

It was the controversies plenary session. Dr. Perez argued neurologists should be primarily responsible for the management of FNDs. It'll be a subgroup of neurologists who do it / like it, but neither your typical community neurologist nor typical community psychiatrist is particularly well-equipped to manage chronic FNDs long-term. New symptoms crop up, and your average psychiatrist isn't going to feel comfortable determining whether it's a functional symptom or structural. A reasonable portion of neurologists are god-awful at dealing with the often (but not always) present psychiatric comorbidities. It's a challenging diagnosis to manage, and no one wants to do it. Good on those who are trying to bring evidence-based care to a neglected patient group. Dr. Perez is doing good work at MGH. Dr. LaFaver has an excellent program at Louisville that deals with functional movement / motor disorders that's had nice results with a brief inpatient rehab (5 days) stay.

Some more neuropsychiatrically-inclined behavioral neurologists, some (not all) movement trained neurologists, and neuropsychiatrists are probably the best group for these folks, but that group isn't large enough, and the patient population is far too common.

I don’t see how it is controversial to try to take care of disabled patients with neurologic symptoms, regardless of etiology. All the pseudoseizures are cared for by epilepsy already.

The controversy is that many, perhaps most of these patients do not accept they have functional do/conversion and then refuse honest care. They then go get diagnosed with chronic Lyme, Magensium or histamine issues, or some nonsense by sympathetic quacks. There are a lot of reasons why no-one wants to do this sort of work and these patients fall through the cracks.

Anyway, if someone wants to see these folks, then that’s awesome.