I’m glad you found this helpful!

You can learn more about FCD here: neurosymptoms.org/en/symptoms/...

Yes starting a new med can be tricky. Anti-anxiety meds can sometimes be very helpful but you are right, it’s a new thing for your body to adjust to & that can sometimes cause problems w/ FND.

I’m concerned you get many patients with FND who are being misdiagnosed & mismanaged.
It doesn’t have to be that way though!

FND is real, reliability diagnosed with validated clinical signs on exam, and treatable.

Please learn 🙏🏼

www.bmj.com/content/376/...

www.nature.com/articles/s41...

Any data to back up what you’re saying? I do and it says you’re wrong 🤷🏻‍♂️

“There are a small number of very specific circumstances where life expectancy is reduced as a result of having ME/CFS - suicide and malnutrition being 2 important examples”

meassociation.org.uk/wp-content/u...

Hi. That is not true at all. It is not a diagnosis of exclusion. It is diagnosed in the exact same way as migraines, Parkinson’s Disease, and other conditions. All diseases do not need to be ruled out.

Here’s a table of positive clinical signs to help rule-in: practicalneurology.com/articles/202...

No. This is not true. Most deaths in people with ME/CFS are sadly due to suicide and starvation. The people with Long Covid who die of heart attacks and strokes are typically not the patients who present similar to ME/CFS. The patients in the above study seem to have the ME/CFS subtype.

That is 100% not true. Organs don’t shut down in ME/CFS or the long COVID subtype that presents similar to ME/CFS after mild infection. This would happen if someone is unable to eat but that is due to lack of nutrition, not disease. The symptoms are not consistent with basic anatomy & physiology.

I disagree. There’s nothing unsafe about them. The only time they could be considered problematic is when the person believes they are unsafe and cannot update that belief. The threat value of energy expenditure and symptoms + excessive self-monitoring will continue to perpetuate the cycle.

…these mechanisms may be accompanied by more frequent cognitive problems and greater perceived effort in task performance, which creates a vicious cycle that results in over-attention on these cognitive symptoms.”

…excessive self-monitoring, attentional bias, negative beliefs about the disease or ageing, health anxiety, perseverative cognition (rumination, obsession, worry), and abnormal emotional processing…

“…global metacognition errors (i.e., errors in the way in which an individual assesses their own cognitive performance) and perfectionism in memory assessment, which ultimately results in low tolerance to memory lapses that may be considered normal in everyday life…

The problem is the perception of energy expenditure required by an activity, not the actual energy expenditure. Engaging in meaningful activities can help reduce the threat of energy expenditure. Treatment aims to reduce excessive attention & threat value of symptoms, not ignore them.

There’s plenty of evidence showing no disease or meaningful tissue damage to explain the condition. People w/ mitochondrial diseases have clear evidence of disease and do not present similarly to people with ME/CFS or Long Covid. This doesn’t make the symptoms, limitations, suffering any less real.

I reject the narrative that there is a clinically meaningful reduction in energy production that is incapable of adapting to controlled increases in physiological demands.

The best evidence shows dysfunction of stress systems and any energy production issues are downstream effects.

I disagree. Sure you can say there’s an assumption of how it works based on the rationale for providing the intervention, but the study was not meant to confirm how it works. It could be the actual CBT elements, therapeutic alliance, something else. Regardless, it was still better than usual care.

As clinicians we look at the body of evidence, not one study. The best available evidence says active rehabilitation. That may or may not change in the future.

Also, medication and surgeries are very different. They tend to come with higher costs and much higher risks including death.

I understand, but the study is still comparing two choices a clinician would recommend to a patient. Based on this study, a clinician should refer to CBT-based rehabilitation. Even if the benefit is mostly due to contextual factors, it did better than usual care with very low risk.

It was a pragmatic study. They weren’t looking at how it worked. They wanted to know if CBT intervention was more effective than usual care. The study results say yes. Rehabilitative treatment always consists of contextual factors & can be considered part of the intervention (therapeutic alliance).