Functional neurologic disorders: Bringing the informal and hidden curriculum to light

Functional neurologic disorders (FND) are among the most common conditions a neurologist will encounter. In 2014, after the publication of an updated Cochrane report on nonepileptic seizures (NES) concluded that there was little reliable evidence supporting any treatment modality, there was a call for further randomized controlled trials, highlighting the lack of priority given to the treatment of NES on the part of both psychiatrists and neurologists.1 Controversy exists about where patients with FND should “live” for their treatment, given a presentation that has symptoms in common with both psychiatric and neurologic disease.2 With current emphasis to rule in the diagnosis of a functional disorder, the expertise of a neurologist is needed to assess a neurologic examination and if possible to determine the non-neurologic nature of the presentation. Treatment, however, remains mainly in the hands of the psychiatrist with psychopharmacology and psychological therapies. There is growing evidence of the efficacy and feasibility of a multidisciplinary approach.3,4

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