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Patients with Parkinson disease are prone to functional neurological disorders
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  • Published on: 24 May 2018
    Aiding diagnosis of suspected patients with Parkinson's Disease and functional disorders

    Dear Editor,

    I read the article entitled "Patients with Parkinson disease are prone to functional neurological disorders" by Hallett M published in the Journal of Neurology, Neurosurgery and Psychiatry (Published Online First: 16 March 2018. doi: 10.1136/jnnp-2017-317684). I want to congratulate the author for this successful article, and make some contributions.

    The article particularly mentions certain aspects of the clinical presentation, medical history and examination of patients, which should raise the suspicion of a functional disorder (1). I think it is important to remember patients with functional disorders will not always adhere to these criteria and clinicians should perhaps consider trialling suspected patients on either cognitive behavioural therapy (CBT) or physiotherapy to assess if they experience any improvement with these strategies. There is increasing evidence to show CBT and physiotherapy are beneficial for patients with functional disorders, hence they may be useful in confirming the diagnosis (2)(3).

    Furthermore, the author suggests patients with functional symptoms and no sign of Parkinson's Disease should not be pursued further for a diagnosis of Parkinson's Disease. I think a difficulty is often deciding what classifies as a sign of Parkinson's Disease. The cardinal symptoms of bradykinesia, resting tremor, muscular rigidity and postural instability are commonly subtle within patients, making...

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    Conflict of Interest:
    None declared.