Our findings will be shared by Dr. Saarah Haque in the Clinical Platform Presentation session this afternoon at the American Neuropsychiatric Association Annual Meeting in Montreal 2/2

@uoftmedicine.bsky.social

Collaboration with our great Sunnybrook multi-specialty Trauma team (ICU, Neuro, Psych and Rehab) and @silverberglab.bsky.social

www.theglobeandmail.com/opinion/arti...

Finally, many of these themes have been articulated by @alancarson15.bsky.social @jonstoneneuro.bsky.social @lauramcw.bsky.social and others...but have not yet made their way to mainstream concussion care. We hope this practical framework helps bridge gaps and increase crosstalk between disciplines

when they may actually benefit most from an opposite approach utilizing CBT-based principles and aiming to reduce symptom preoccupation, redirect attention, reframe beliefs, and encourage graded exposure to avoided activities (reducing fear avoidance behaviors).

We try to summarize the implications of these issues through a case vignette in the Online Supplement. We discuss how a patient with FND triggered by head injury may be harmed by some standard PCS/PPCS rehabilitation protocols that encourage close monitoring of symptoms etc

We also hone in on Curve 3 - synergism between concussion and FND presenting a potential ‘two hit’ hypothesis to the same/vulnerable brain circuits. We had to squish this into the figure legend due to word limits...but certainly worth a read.

This includes discussion of brain/body threat signaling mechanisms and nocebo effects (negative expectations generating/amplifying symptoms). The latter can be induced by well-intentioned public health campaigns, media coverage of rare cases with catastrophic outcomes etc.

In this piece, we start with a general intro to FND for a sports/ER/generalist audience who may be largely unaware of or hold misconceptions about FND. We then explore traditional and emerging models for how/why head injury is increasingly triggering FND in patients

Ignoring this diagnostic heterogeneity has significantly held back concussion research and continues to impact patient outcomes

These curves are often wrongfully all given the same label of post-concussion syndrome/symptoms (PCS/PPCS)...but some patients may have not even had a concussion in the first place (FND triggered by head/neck injury) and others may have a complex interplay between concussion and FND.