The borderland of multiple sclerosis and functional neurological disorder: A call for clinical research and vigilance

Background and purpose Functional neurological disorders (FNDs) have attracted much attention from the neurological medical community over the last decades as new developments in neurosciences have reduced stigma around these by showing brain network dysfunctions. An overlap with other neurological conditions such as multiple sclerosis (MS) is well known by clinicians but there is a lack of clinical and fundamental research in this field to better define diagnosis and therapeutic decisions, as well as a lack of deep understanding of the underlying pathophysiology. Aim We aimed to provide a critical commentary on the state of knowledge about the borderland between FNDs and MS. Methods We based our commentary on a joint point of view between an FND specialist and an MS expert. Results A brief review of the previous literature and relevant new studies covering the overlap between FNDs and MS is presented, along with suggestions for future research directions. Conclusion There are clear diagnostic criteria for both FNDs and MS and a strict application of these will help better diagnosis and prevent unnecessary treatment escalation in MS or absence of referral to multimodal therapy in FND. Better teaching of younger neurologists is needed as well as prospective research focusing on pathophysiology.

Automated summary

This article provides a critical commentary on the overlap between functional neurological disorders (FNDs) and multiple sclerosis (MS). Despite clinical similarities, there is a lack of research in defining diagnosis, therapeutic decisions, and underlying pathology. The authors suggest strict adherence to diagnostic criteria, better training for young neurologists, and more research on pathophysiology.