#FND left me housebound for many years, unable to walk or use my arms. The turning point came when I met Prof Mark Edwards & finally received diagnosis & treatment. It’s still a battle but I am starting to play again. I hope my story shows with the right treatment, there is hope.

Functional Neurological Disorder is now recognised as one of seven core neurology subspecialties within NHS England, with national clinical pathways in England, Wales and Scotland. Recognition is progress. Now it's time for all #NHS services to reflect it in practice. #FND

How people’s stories can help recovery recovery-channel.org/how-peo…

Patients needed for #FND research at Kings college london, If you are interested in taking part details are below-

🌱 Can reading recovery stories help recovery itself? There’s growing evidence that hope, positive expectations and shared experiences matter. #FND and #ME/#CFS and #Chronic pain have important overlaps. Here is a wonderful collection of recovery stories for ME/CFS/Chronic pain👇 recovery-channel.org/recover… recovery-channel.org/how-peo… #FND #MECFS #Recovery @PaulGarnerWoof @Fionas_Story

Current UK #FND research study. The BRaVE-FND study is exploring whether brain-computer interface technology, using EEG, virtual reality and electrical stimulation, could support rehabilitation for people with Functional Neurological Disorder. Recruiting. slam.nhs.uk/project-details-…

Scottish TV (STV) news item on FND on 4th Oct zurl.co/hHaHD STV link if you are in UK zurl.co/P6zxI With thanks to Glasgow FND Support Circle -zurl.co/DOLwb

New research study! 🎺 Can surgery or anaesthesia worsen/trigger FND? Please help Alex Lehn with this study if you are ✅18+ ✅ have a diagnosis of FND ✅ have had 1 or more procedures with general/local/regional anaesthetic/sedation Join here zurl.co/TOAJz

mind and body are an interconnected system- you could argue that everything is psychogenic, rendering the term meaningless, there may be tiny proportion of patients who have genuine health anxiety, but mostly somatoform is a lazy/simplistic label for poorly understood conditions

Psychogenic or somatoform is the language of mind body dualism, the implication being if we can't find anything structurally wrong with you then it is all psychological, neuroscience has demolished this division between mind and body, so I reject the psychogenic construct -

(1/2) What is Parkinson’s disease? What is a Functional Neurological Disorder (FND)? How many neurological labels have a basis in the same neural responses? I’ve performed this to even a greater degree in two movement disorder, offices and there was no curiosity/belief….🧵

If you are a UK FND health professional follow @ukfndnetwork for updates and information UK FND network aims to connect health professionals and patient led organisations to improve services for people with FND

Scamvougeras & Castle argue for psychiatric primacy yet where is the patient outcome data supporting it? Treating psychiatric comorbidity isn’t evidence that psychiatry is the engine of FND. Without better FND outcomes, this looks more like a claim for ownership, not progress 6/6

Scamvougeras & Castle argue that Functional Neurological Disorder should primarily be understood as psychiatric. Jon Stone challenges this. But their proposal raises an uncomfortable historical question about what happened to patients when psychiatry was dominant. #FND 🧵

Jon Stone has written an excellent response to Scamvougeras and Castle’s argument that FND is fundamentally psychiatric. I agree with all of it. The neurology vs psychiatry framing itself gets in the way of understanding patients and providing effective care. The patients I evaluate and treat vary considerably. Some have relatively straightforward presentations, with habitual, involuntary movement patterns that respond very well to sensorimotor retraining. Others have no diagnosable psychiatric condition, but psychosocial factors such as fear, shame, cognitive rigidity, etc appear to contribute substantially to symptom onset and persistence. Others have multiple psychiatric comorbidities, and psychiatric or psychological treatment is central to their progress. Across these presentations, I find coordinated multidisciplinary care most useful, with the balance of treatment reflecting each person’s needs. These differences don’t require placing patients on a line between “neurological” and “psychiatric.” Each person has their own combination of interacting biological, psychological, and social/environmental factors. As Stone explains, describing the brain mechanisms involved in a symptom is different from explaining why that person developed it. Understanding altered motor control doesn’t exclude psychological contributions, and identifying psychological distress doesn’t fully explain how someone develops a particular movement, weakness, or seizure. A psychological contribution also doesn’t require a psychiatric diagnosis, and having a psychiatric diagnosis doesn’t establish the cause of someone’s neurological symptoms. This is why I love the pie chart analogy created by Julie Hershberg and her team at re+active. I explain to patients that we can think about their condition through the interaction of factors that increased their vulnerability, events that may have triggered symptoms, and things that now keep those symptoms going. Picture a pie divided into slices representing psychosocial, lifestyle, physical impairments, motor control, sensory processing, and autonomic factors. For some people, psychosocial and lifestyle factors appear to make up much of the pie. For others, sensory and physical impairment do. For many, several areas contribute equally. The slices interact, their relative importance can change, and what maintains symptoms may (and often does) differ from what initially triggered them. The pie is a shared working formulation, rather than a precise measurement of causation. Patients often respond very well to having this visual representation of their difficulties and understanding why we’re recommending particular treatments. It also helps us identify what we may have overlooked. I find it difficult to imagine treating this population well without some version of this individualized, integrated approach. I see the consequences of narrower thinking in both directions. Some clinicians and patients emphasize neurological mechanisms so heavily that psychological and social contributors go unexplored. Others assume a psychiatric explanation is sufficient and overlook the need for neurological assessment or rehabilitation. In either case, the explanation can start determining what the clinician is willing to see. One particularly troubling mistake I encounter, especially from mental health professionals but sometimes from neurologists, is concluding that symptoms are too severe to be functional. Patients report being told, “This is clearly neurological; your mind can’t make you have these symptoms.” Symptom severity doesn’t distinguish FND from another neurological condition. Establishing the diagnosis requires neurological expertise, an appropriate examination, and positive clinical evidence. This is why I believe neurologists need to take a central role in diagnosis and remain involved in management where needed.