Thread by @dysclinic

Participated in a very interesting multidisciplinary POTS conference at @HopkinsMedicine on the topic of #FND, #syncope and #POTS where we discussed and debated the numerous issues surrounding FND diagnosis in our patient population. 1/🧵
#MedTwitter #NeuroTwitter

@HopkinsMedicine After conference, saw a patient who highlighted the issues discussed at conference.
👩‍🦽30 yo woman with POTS/MCAS/EDS triad with one TTT positive for POTS, but a 2nd TTT negative
❌ A neurologist diagnosed her with FND
💉 She is on allergy shots & many H1/H2 blockers.
2/🧵

@HopkinsMedicine 🚫 Neurologist didn't take into consideration neurologic and psychiatric manifestations of SYSTEMIC DISEASE (MCAS)
❌ This is not FND because there is underlying systemic disorder driving symptoms and signs.
🧠 Patient needs to be treated for the SYSTEMIC DISORDER first.
3/🧵

@HopkinsMedicine Common scenario: internists, allergists & rheumatologists are not familiar with neurologic and psychiatric manifestations of systemic disease while many neurologists and psychiatrists are not aware of the wide spectrum of neuropsych manifestations of systemic disorders.
4/🧵

@HopkinsMedicine Misuse of FND diagnosis then becomes a knee-jerk reaction instead of thoughtful review and recognition of numerous neurologic and psychiatric symptoms and signs that patients with autoimmune, inflammatory, hematologic, neoplastic and hormonal disorders may develop.
5/🧵

@HopkinsMedicine ✅ Important to work together as a multidisciplinary team - patient care should not be an ego competition!
✅ Reach out to a specialist for a 2nd opinion before confirming your diagnosis - no shame in asking for help!
✅ Keep an open mind & don't close the door on diagnosis. 6/6