Functional shades of grey
Functional shades of grey
Functional neurological disorders (FND) are conditions in which people experience symptoms such as weakness, tremors, or seizures, that result from changes in how brain networks function, rather than from structural abnormalities.
This thesis of Tjerk Lagrand aimed to improve the diagnosis, management and understanding of FND. Traditionally seen as a psychiatric problem, FND is now recognized as a neurological condition that benefits from a biopsychosocial approach, acknowledging the interaction between biological, psychological, and social factors.
Research described in this thesis showed that, besides physical examination findings (‘positive signs’), clinical features from the patient’s history - such as sudden onset, fluctuating symptoms, fatigue, and psychiatric history - help distinguish FND from other disorders. Combining these features in predictive models improved diagnostic accuracy to nearly 90%.The studies also explored driving ability and healthcare use among FND patients. Findings showed that while their hazard perception is intact or even enhanced, physical symptoms can still affect driving performance. Importantly, when patients receive a clear and satisfactory of their diagnosis, healthcare use drops dramatically.
Effective care requires multidisciplinairy, stepped-care approaches, tailored to the individual. Collaboration between neurologists, psychologists, physiotherapists, and other professionals ensures that patients receive the right care at the right time.
Overall, this thesis emphasizes that FND care should balance scientific structure with individual flexibility. Understanding the ‘grey areas’ between neurology and psychology is essential to improve diagnosis, treatment, and patient well-being.