Expert Insights on Neurological Research

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Foreign Accent Syndrome

Foreign Accent Syndrome (FAS) is an uncommon speech disorder where individuals develop a new, seemingly foreign accent in their native language. This review explores FAS within the contexts of functional neurological disorders (FND) and mild traumatic brain injuries (mTBIs).

In FNDs, FAS is often classified as a functional speech disorder, where no definitive structural brain lesions or neurological causes are identified. Cases suggest a psychogenic or functional origin, possibly triggered by psychological stress. Studies highlight that FAS in FNDs features inconsistencies and intermittency in speech patterns, which can occur even in the presence of structural brain damage.

In mTBIs, FAS can emerge without significant structural lesions visible on imaging. Reports indicate that even minor head injuries might lead to FAS, with functional or metabolic brain changes undetected by standard imaging techniques. For instance, abnormal functions in specific brain regions, such as the left dorsolateral inferior frontal gyrus and caudate nucleus, have been implicated.

Overall, the occurrence of FAS in both FNDs and post-mTBI contexts underscores the complexity of this speech disorder and the need for integrated diagnostic and therapeutic approaches. The studies reviewed suggest that functional and metabolic assessments, alongside behavioural interventions, are crucial for understanding and managing FAS effectively.

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Misdiagnosis in Functional Neurological Disorders (FND)

Functional Neurological Disorders (FND) present with symptoms that lack clear organic causes and mimic other neurological disorders. This overlap complicates diagnosis and significantly increases the likelihood of misdiagnosis. Traditionally considered a diagnosis of exclusion, the approach to FND has shifted towards inclusion based on specific clinical indicators. Despite advancements in diagnostic techniques and a growing understanding of FND’s pathophysiology, misdiagnoses remain common. These are often exacerbated by persistent misconceptions, such as viewing FND as solely psychological or suspecting symptom feigning. Misdiagnoses lead to inappropriate treatments, which are costly, potentially harmful, and psychologically damaging to patients. This paper reviews the challenges and impacts of FND misdiagnosis, emphasizes the importance of an informed, multidisciplinary approach for accurate diagnosis, and suggests advancements in neuroimaging and clinical education as critical tools for improvement.

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Diagnosis of functional neurological disorder

he diagnosis of Functional Neurological Disorder (FND) represents a challenging but critical endeavor in neurology and psychiatry, requiring an integrated approach that transcends traditional diagnostic categories. This paper outlines a comprehensive framework for diagnosing FND, emphasizing the importance of direct clinical assessment, the strategic exclusion of other neurological and medical conditions, and the identification of characteristic positive signs. Contrary to being a diagnosis of exclusion, FND involves specific, identifiable signs such as Hoover’s sign, distractibility, and other non-physiological findings. These markers facilitate a positive diagnostic outcome, reinforcing that FND symptoms are genuine and rooted in functional impairments rather than structural abnormalities. Furthermore, the method of communicating the diagnosis to patients significantly affects their understanding, acceptance, and engagement in subsequent treatment, which can include physical therapy, psychotherapy, and medication. By providing a clear diagnostic pathway that incorporates both neurologic and psychiatric expertise, this paper aims to enhance the accuracy of FND diagnoses and improve patient outcomes through tailored, multidisciplinary care.

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Functional Cognitive Impairment Following Mild Traumatic Brain Injury (mTBI)

Functional cognitive impairment (FCI) post-mild traumatic brain injury (mTBI) presents a significant challenge, often manifesting subtle symptoms that persist well beyond the healing of physical injuries. The primary causative factor is the brain trauma itself, which disrupts normal cognitive functioning and is exacerbated by metacognitive impairments, psychological factors such as depression and anxiety, and physical symptoms like fatigue and headache. Despite normal results on traditional neuropsychological tests, affected individuals may struggle with daily cognitive tasks, impacting their quality of life. While treatment options like transcranial Direct Current Stimulation (tDCS) and cognitive rehabilitation programs show promise, the prognosis for FCI varies widely, dependent on several factors including the severity of the initial injury and individual health conditions. Emerging research using techniques like [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) offers new insights into prognosis, enhancing understanding and management of FCI.

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Legal and Ethical Concerns in the Diagnosis of Functional Neurological Disorders

Functional Neurological Disorders (FND) are characterized by neurological symptoms that are not explained by identifiable neurological disease. The diagnosis of FND is complex and requires a careful approach to avoid misdiagnosis, which can have significant legal and ethical implications. Misdiagnosis can lead to unnecessary treatments, psychological harm, and a lack of informed consent. Studies have shown that misdiagnosis rates for FND are similar to those for ‘organic’ neurological diseases, and the misdiagnosis of neurological diseases as FND occurs at a similar frequency. The challenge is compounded when patients have comorbid conditions, such as multiple sclerosis, where both conditions need to be treated. Ethical concerns include the potential for stigmatization of patients, the responsibility of healthcare professionals to correct public misinformation, and the importance of accurate communication of diagnoses. Legal concerns revolve around the accuracy of diagnosis, informed consent, and confidentiality. To address these concerns, enhanced training for healthcare providers, development of guidelines for media engagement, and multidisciplinary approaches to assessment and treatment are recommended. The goal is to ensure that patients receive accurate diagnoses and appropriate care, while healthcare providers navigate the ethical and legal landscape with due diligence.

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Emerging Biomarkers in Functional Neurological Disorders: A Synthesis of Current Research

Functional neurological disorders (FNDs) present a diagnostic challenge due to the absence of definitive biomarkers. This synthesis of current research explores the potential biomarkers for FNDs, aiming to enhance diagnostic accuracy and treatment efficacy. Cortisol levels have been investigated as state, trait, and prognostic biomarkers, reflecting the stress response and potential chronic alterations in hypothalamic-pituitary-adrenal axis functioning in FND patients[1]. Whole-body cryostimulation (WBC) has been proposed as an adjuvant treatment, with a case report demonstrating improvements in body composition, hematological biomarkers, and physical performance, suggesting physiological responses to WBC as potential biomarkers for treatment efficacy[2]. Vitamin B12 deficiency, often resulting from nitrous oxide misuse, has been identified as a consistent feature in hospital admissions for neurological disorders, indicating the importance of metabolic biomarkers in patient management[3]. Functional near-infrared spectroscopy (fNIRS) has been utilized to derive objective hemodynamic biomarkers, with machine learning algorithms demonstrating high accuracy in classifying neuropsychiatric disorders, underscoring the potential of fNIRS in the objective diagnosis of FNDs[4]. Additionally, glutamatergic dysfunction, neuroplasticity, and redox status in peripheral blood have been explored as potential biomarkers for motor conversion disorders, a subtype of FNDs[5]. This body of research signifies a shift towards identifying unfeignable biomarkers that could unravel the complex etiology of FNDs and guide more targeted interventions[6][7].

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Risk Factors for Functional Cognitive Impairment after Mild Traumatic Brain Injury

Mild traumatic brain injury (mTBI) poses a risk of long-term functional cognitive impairment (CI), influenced by diverse pre- and post-injury factors. This review synthesizes current research on the risk factors associated with CI following mTBI, drawing from recent findings in neuropsychological assessments, neuroimaging studies, and genetic analyses. Pre-injury comorbidities such as psychiatric conditions and hypertension, alongside demographic factors like age and gender, have been identified as significant contributors to post-mTBI cognitive challenges. Additionally, injury-specific symptoms including fatigue and headaches are crucial predictors of CI. Neuroimaging techniques, including functional MRI and diffusion tensor imaging, reveal changes in brain structure and connectivity that correlate with cognitive deficits. The presence of the Apolipoprotein epsilon 4 allele also heightens the risk of CI and interacts with other conditions such as Alzheimer’s disease. Methodologically, the research utilizes cross-sectional and longitudinal studies to map the progression of CI and employs statistical analyses to elucidate significant predictors. This comprehensive approach underscores the complexity of diagnosing and managing CI post-mTBI, highlighting the need for targeted intervention strategies based on individual risk profiles.

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