Christoff Truter
Posts
3
The Common Phenotypes Hypothesis
An exploration of FND, positive rule-in signs, comorbidity, predictive processing, diagnostic closure, and whether functional symptoms may reflect common phenotypes arising from multiple underlying conditions.
Advice from an FND Sceptic for Those Newly Diagnosed
What advice would I give to anyone newly diagnosed with this disorder? Advice that I wish I had received back then?
FND: A Diagnosis That Shuts Doors?
A critical examination of Functional Neurological Disorder, its historical roots, diagnostic evolution, and whether the shift to a positive diagnosis risks closing the door on further investigation.
Comments
38Yeah, that's the first website most patients diagnosed with FND are directed to, along with https://neurosymptoms.org
It is very strange, isn't it?
@Copper Comet of Lagoon Just out of interest (I'm not sure what your background is, cons of anonymous comments), based on your comment, am I right in thinking that you consider the CSF leak to have been incidental and the surgery unnecessary? That doesn't appear to be the interpretation of the authors.
If so, and assuming you're a clinician, wouldn't that make you less likely to consider or investigate a CSF leak as a differential diagnosis in a similar patient? That's what concerns me.
@Copper Comet of Lagoon Your comment inadvertently illustrates exactly the point of the post. Even though the patient had remained symptom free for up to three months after the CSF leak was repaired, you preserve the FND diagnosis through explanations like functional overlay, comorbidity, placebo, attention, predictive processing, or by questioning the significance of the repair itself, something the authors of the paper do not question.
One other point is that the paper itself does not treat the CSF leak as an incidental finding or question whether it required repair. Those are additional interpretations. The authors accepted it as a curable underlying pathology, repaired it, and reported complete symptom resolution, yet still retained the FND diagnosis.
So contractures form from severe holding of muscles in FND. Even when you "cure" the FND, it's too late. When we look at these muscles on ultrasound, they are completely damaged and fibrotic. Very different than a stroke or neurological disorder. I work with an orthopedic surgeon pic.twitter.com/R5bIln5pH8
- Paul Winston MD - Restoring Movement is the goal. (@drpaulwinston) June 4, 2026
Discussions started
2You can literally go onto https://fndconnect.org.uk/shop/product/fnd-connect-i-have-seizures-lanyard-and-card
And for £ 4.99 you can buy yourself a lanyard to inform bystanders to effectively discourage appropriate emergency care.
Someone may assume every episode is "just another functional seizure." But seizures can change, suffer a head injury, have a stroke,
low blood sugar, cardiac syncope, or another medical emergency.
Looking back, was there a symptom(s) that should have prompted doctors to investigate further before diagnosis FND?
What always boggles my mind is how quickly skepticism about the FND label, especially in cases like this one, gets framed as denial or something harmful. Skepticism is not denial of the symptoms or the suffering. It is a legitimate response when the patient themselves says they don't understand how the diagnosis was reached, no clear positive clinical signs or explanation were communicated, and it felt like a nothing else fits conclusion, with no real treatment plan or forward path.
Shouldn't the priority be listening to the patient's actual experience and asking why the diagnostic process wasn't more transparent? Good medicine welcomes questions and second opinions, especially with sudden, purely cognitive changes that have devastated someone's career and daily life.
Why discourage exploring reasonable alternatives such as Long COVID related brain fog, POTS, autoimmune encephalitis, microbiome issues, and so on? Considering differentials doesn't invalidate FND if that is the right fit. It just protects the patient from a potentially premature label. Many of us have seen cases where digging deeper changed everything.