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Functional Neurological Symptom Disorder: A Diagnostic Algorithm.

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Functional neurological symptom disorder (FNSD) diagnosis is aided by a new clinicoradiological algorithm using PET and SPECT scans (PoSPs). This tool identifies hypoactivation patterns, helping differentiate FNSD from organic conditions.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Medical Imaging

Background:

  • Functional neurological symptom disorder (FNSD) presents neurological symptoms without clear pathology, often leading to extensive testing and diagnostic uncertainty.
  • Diagnosis is typically one of exclusion, causing patient distress and significant healthcare costs.
  • A reliable imaging biomarker could confirm FNSD, improving patient and clinician confidence.

Purpose of the Study:

  • To develop and validate a clinicoradiological correspondence algorithm for FNSD using PET and SPECT scans (PoSPs).
  • To provide clinicians with a reliable tool to aid in the diagnosis of FNSD.
  • To investigate the clinicoradiological features and temporal stability of brain activity in FNSD.

Main Methods:

  • A systematic review following PRISMA criteria was conducted.
  • The study included 3 own patients and data from 25 patients across 7 studies meeting DSM-5 criteria for FNSD.
  • A clinicoradiological correspondence algorithm using PET and SPECT scans (PoSPs) was developed.

Main Results:

  • Results indicated hypoactivation in the frontal lobe, associated with behavioral alterations.
  • A poor clinicoradiological correspondence and temporal stability of this hypoactivation pattern were observed.
  • These findings contrast with patterns seen in organic neurological pathologies, supporting an FNSD diagnosis.

Conclusions:

  • The study recommends using the PoSPs algorithm to assess clinicoradiological non-correspondence and temporal stability in suspected FNSD cases.
  • The identified hypoactivation pattern, particularly in the frontal lobe, may serve as a diagnostic indicator for FNSD.
  • This approach aims to reduce diagnostic delays and improve patient outcomes for FNSD.