Alan Carson
@AlanCarson15
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Neuropsychiatrist Royal Infirmary of Edinburgh and Professor University of Edinburgh, Associate Editor JNNP, President FND Society
Joined June 2015
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Recognising and explaining functional neurological disorder | The BMJ. Our guide to FUnctional Neurological Disorders in primary care
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Mortality in patients with psychogenic nonepileptic seizures | Neurology. Important paper. PNES same mortality rate as drug resistant epilepsy- we found hints of this in our SNSS study. Lets start taking this as seriously as it deserves
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Functional cognitive disorders: a systematic review - The Lancet Psychiatry.
@lauramcw
made a fantastic effort on this paper; I hope it has the impact it merits. We think this is important for anyone working in fields of dementia or brain injury.
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@SkyNewsBreak
@AlbertoCostaMP
well done for acting with decency and trying to protect rights of brits in europe and europeans who have done us the honour of choosing to live here. Seems
@Anna_Soubry
was on the money with her comments on
@theresa_may
and immigration
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Functional Neurological Disorder in people with Long-Covid: A Systematic Review - PubMed
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Our comments on dualism and FND in this months World Psychiatry
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First day of walking through front door of our new neuroscience hospital- there have been some well publicised teething problems- but the end result is pretty bangin’
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Psychiatric sequelae of traumatic brain injury — future directions in research | Nature Reviews Neurology. Pleased to see this out- the wonderful
@NeuroDocLucia
did the heavy lifting
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@Dr_BellaR
If only we had terms like house office, Senior house ifficer, registrar and senior registrar
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Mark Edwards nails not just FND but also a large part of medical practice in one slide. The whole talk is available at the
@FNDSociety
website but i m afraid you have to join if you missed it live- but then you should join anyway
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Silver wedding anniversary today- as much fun now as it was then
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@krishgm
Why would you be shocked by managerial response- its been identical in every major NHS scandal- unless we can change culture to get senior managers to welcome hearing ‘bad things’ we wont improve
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The British guideline for CFS/ME is the result of activism, not research. Patient experience is important but we need to remember there is no such thing as a typical patient and be aware of excluded voices
@NICEComms
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The notion of an essay on Functional Neurological Disorders winning a
@Brain1878
essay prize was unimaginable when i started in a then obscure field of research 28 years ago- we ve come a long way- congratulations to
@popkirov
but also
@MasudHusain
for editorial leadership
January issue of
@Brain1878
now out
with 'Double Vision', the winning contribution in our Essay Competition by
@popkirov
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“Scan-negative” cauda equina syndrome: A prospective cohort study | Neurology.
@IngridHoeritza1
phd study out today. There are a lot of take home messages on CES. PR a waste of time but do check those ankle jerks- much more inside.
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@DinahGLRoseKC
If your prediction holds true, and given your expertise, i assume it will- it will be a very bad day for parliament and indeed the law. The electorate cares about this issue and we ve all seen the photos.
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@jimwaterson
@StopFundingHate
This is a form of gaslighting - noone from BLM is suggesting Churchill’s statue should come down and to start a campaign like this leads directly to the scenes we saw yesterday - its highly irresponsible
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For thos interested in our sonic attacks paper- here is the accompanying graphic
@TheLancetNeuro
@TheLancetPsych
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@JeremyVineOn5
@alex_polizzi_
@theJeremyVine
I m roughly the same age and 30 years ago groping someone’s thigh under the table at a business meeting was ( correctly) regarded as a sackable offence/ and socially would get a well earned slap. What arrent nonsense to normalise this
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A periodic reminder that FND has an underpinning biology- as must all symptoms
Sharing article led by Dr. Sara Paredes-Echeverri on Autonomic, Endocrine, & Inflammation Profiles in Functional Neurological Disorder: A Systematic Review & Meta-Analysis.
@MGHNeuroSci
@indrit_begue
@susannah_pick
@Tim_R_Nicholson
@FNDHope
@FNDSociety
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The phd we re offering in functional cognitive disorders is a fantastic opportunity- as are the other phds in the programme- all include time in a second participating centre and with a private industry partner
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@sjblakemore
I think we are getting this very wrong. Should be setting up dedicated out door social venues where students can mingle. But discourage from general community venues.And offering dedicated testing facilities. risks from loneliness may outweigh corona risks for this population
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On International Women in Science Day i d like to highlight m two fabulous colleagues
@lauramcw
and
@IngridHoeritza1
who combine being sensational clinician scientists with the best craic
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The neurology of the Cuban “sonic attacks” - The Lancet Neurology. Really pleased with this paper- i like to think it has some helpful insights about cuban ‘attacks’ but more importantly about functional disorders in general
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@emahase_
@bmj_latest
@TheDA_UK
@CNagpaul
Correct decision but this should have been made when case first arose. I hope there will now be a proper investigation of actions of clinical management team who pushed this claim forwards
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It’s my wonderful daughter’s 18th birthday today- she was supposed to be celebrating with her friends on the beautiful island of Hvar but, like so many plans, it had to go & instead she is stuck with me. The company may be dull for her but at least the wine will be better quality
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@devecs
@jamiesusskind
@davidallengreen
Science degrees- learn to make a theory then test it. And if evidence doesnt support it drop the ides
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Next Thursday’s
@FNDSociety
webinar will be by Joe Jankovic speaking on dystonia- organic v functional. Joe is an absolute guru of dystonia so should be good. Free - Sign up at (pictured here at Ed FND conf-in happier times!)
@kailashbhatia
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Every now and then there is an essay that is just a bit better than the rest.
Mark Edwards discusses what functional neurological disorders reveal about modern medicine, and argues that the passivity of the traditional sick role needs replacing with a participatory, rehabilitative medical practice.
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After years of literay theorists and historians doing feminists citiques of hysteria, that were clinically illiterate, here’s one from people who ve actually done the hard yards on the shop floor- I think this will become a classic
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@wendyburn
I don’t wish to comment on the individual concerned but isn’t displacement exactly the point. Medical staff feeing chronically undervalued and not respected.
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Functional Cognitive Disorder: Diagnosis, Treatment, and Differentiation from Secondary Causes of Cognitive Difficulties - ScienceDirect. Particularly relevant for those working with early onset dementia, mTBI/ concussion and long covid
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This Thursday’s
@FNDSociety
webinar will be by Tim Nicholson on the complex relationship between FND and traumatic events. Many years, ago I examined Tim’s phd on this topic. Trust me, no one better to give this talk. Visit society website for details
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Chronic fatigue syndromes: real illnesses that people can recover from
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At least 69 suicides linked to DWP's handling of benefit claims - extrapolating from the distress i see in every clinic i would be surprised if the number was as low- the stories of the process are gut wrenching
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@UKGastroDr
They all get private healthcare as part of their GMC renumeration package. Something that should be stopped instantly- i object strongly to paying for it- they should have to rely on nhs- would focus their minds
@gmcuk
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Management of mild traumatic brain injury | Practical Neurology. Here’s our thoughts on assessment and treatment of mild brain.
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This was very poor- if we set up long covid as either physiological ie real versus mental not real we will fail patients. This distinction is neuroscientifically illiterate. All mental disorders have a physiology and are real. In detailed phenotyping studies we find a lot of FND
"
#LongCovid
is our next public health disaster in the making"
@NEJM
Estimated 15 million US cases are affected
@StevePhillipsMD
and
@HarvardChanDean
map out a 5-point approach and why this is such an urgent matter
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Functional neurological disorder after vaccination: a balanced approach informed by history | Royal College of Physicians of Edinburgh- as ever there is nothing new- we just fail to learn the lessons
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So we know that it’s rare that FND diagnoses turn out to be wrong. What about the other way round- how often do other neurological disorders turn out to have been misdiagnosed FND all along?
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My delightful wife’s birthday- 33 years together and counting. How to celebrate? Kids had answer a Smiths tribute band, we even took a double decker bus home
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@nataliesurely
What troubles me about this whole conversation is that so many people take the explicit starting point that if long covid does ultimately prove to be functional that it is in some wsy a less worrhy condition
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Expanding the therapeutic toolkit in functional neurological disorder: consensus recommendations for speech and language therapy | Journal of Neurology, Neurosurgery & Psychiatry
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So just of phone from international conference call- its done, an international society: the Functional Neurological Disorders Society is go. Due for legal incorporation in next couple of weeks. More news to follow...
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This Thursday’s
@fndsociety
webinar is on physiotherapy by the wonderful
@GNielsen_Physio
(middle) . & with discussion from
@kailashbhatia
all chaired by
@valvoon
if you haven’t heard Glenn speak before you will have your eyes opened.
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Next Thursday’s
@FNDSociety
webinar will be by Stoyan Popkirov on Emergency presentations of FND- this is a reall problem area so tune in 11EST free to access live but must register at
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@trishgreenhalgh
Maybe the problem is your use of dismissed which implies one form of aetiology as more worthy than another- as far as neurological symptoms go there is mounting clinical and scientific evidence of a functional cause but this doesn’t mean the patient is any less sick or deserving
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Webinar Registration - Zoom the first of our new FND education programme goes live Thursday 14th May. Free access but must register in advance. First talk Dr Mark Hallett on an introduction to FND. Mark is Chief of Human Motor Control NINDS- it’s a goodie
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Plans to shorten medical training It is easy to think of medicine as countable procedures - cataracts endoscopy etc but most of it is complex decision making in multi morbidity and differentials- shortening training will likely backfire in litigation costs
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Occupational therapy consensus recommendations for functional neurological disorder | Journal of Neurology, Neurosurgery & Psychiatry. Clare Nicholson who led this project will be presenting it as the
@FNDSociety
webinar on Thurs 6th Aug- tune in
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The role of evidence-based guidelines in the diagnosis and treatment of functional neurological disorder - ScienceDirect
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This is an interesting area. Had 7 or 8 cases with functional parkinsonism for up to a decade before PD emerged. Also cases of functional motor symptoms preceding FTD by around 1 year. Presumably very early subtle motor sequencing difficulties form nidus for FND in the vulnerable
A new potentially malignant subtype of Parkinson presented by
@AlbertoEspay
If functional symptoms before PD diagnosis this may be a 'red flag.' Keep your eyes on how this story plays out.
@movedisorder
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Disrespectful language about patients with long COVID - The Lancet. Says it all really- there should be no doubting the deep layers of prejudice that underpin some of the language, assumptions and discussion around long covid
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Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda - ScienceDirect. Well led by
@PerezMGHLab
sema aybek and
@Tim_R_Nicholson
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My reflections on capgras
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If anyone doubts what stigma looks like just read what the typical medic / academic suffering LC has to say when it is even suggested that some long covid symptoms may be functional - then think wonder what sort of attitudes patients with FND face
@nataliesurely
What troubles me about this whole conversation is that so many people take the explicit starting point that if long covid does ultimately prove to be functional that it is in some wsy a less worrhy condition
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Hiding in Plain Sight: Functional Neurological Disorders in the News | The Journal of Neuropsychiatry and Clinical Neurosciences. Interesting observations on recent news stories and how often supposedly ‘rare’ diseases prove to be functional
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There is a real need for greater awareness and understanding of functional cognitive disorders- anyone seeing patients with dementia needs to be competent - ABN have defined as core skill for neurologists/ psychiatry paradoxically have been more reluctant to get up to speed
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@GoStargazing
@treesey
Remarkable- goes beyond vandalism and must have required significant equipment and knowledge- but why on earth would you do that- who hates a tree in middle of nowhere
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One of
@FndPortal
most important threads - bang on the money of pain in fnd. Also seen it apply to CRPS
Hey so, normally I don’t share detailed health information here, but something’s happened recently and I thought I should describe it in case it’s helpful for anyone else w FND.
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@TheLancetPsych
@joannamoncrieff
Well well well antipsychotic maintance had no negative impact on social function but significantly reduced relapse rate
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Interesting trial- once again showing rehabilitative exercise is beneficial in fatigue states- there comes a point where
@NICEComms
is going to have to recognise the harm their anti- scientific guidance is doing
A randomized trial for
#LongCovid
in 589 participants showing quality of life benefit for an 8-week, individualized, online, home-based, supervised group physical and mental rehab program (REGAIN) compared with usual care at 3 and 12 months
@Gord_McG
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Provisional Program | FNDS. Programme for FNDS Boston 2020 is out- its looking good
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Yesterday more reasons for psychiatry and neurology to work together- Psychological precursors of epileptic seizures - Michaelis - Epilepsia - Wiley Online Library
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Next Thursday (14 th Jan - 11h EDT/ 16h GMT) FND society webinar will be Christos Ganos speaking on functional tics and repetitive movement disorders. We re expecting a thought provoking presentation so join us- free to view to register
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With the fabulous Bettina Balint about to start Zurich Fnd symposium
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Functional Neurological Disorder Society will hold it inaugral meeting in Boston on 14-16 June 2020. It follows from international meeting held in Edinburgh generously supported by
@movedisorder
@NINDSdirector
@CathCalderwood1
. We’re delighted with BU venue+ cheap accommodation
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@wendyburn
@dr_dr_uk
@trentconsultant
@rcpsych
If that happened would be very helpful but one of the issues is that people get bored doing the routine health management and want more interesting roles so they negotiate them as a permanent presence- all too easy for task to fall back on the rotating trainees
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Podcasts | FNDS. We re only a week away from inaugural scientific meeting of FND Society- its still possible to register for online- if you’re swithering have a listen to these podcasts to get you in mood and check out the program- i m biased but its fab!
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Wellbeing classes do not improve workers’ mental health, research suggests. No surprise- basics - respect, paying staff rather than 3 months chasing, doing rotas well, avoiding meaningless paper work=a difference
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Performance validity test failure in clinical populations—a systematic review | Journal of Neurology, Neurosurgery & Psychiatry. Do ‘effort’ tests really work- not in terms of informing diagnosis. High failure rates in patients with dementia and severe TBI
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Rannoch moor - if it was a teenager it would paint its bedroom black and slam the door
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This Thursday’s
@FNDSociety
webinar will be a multi disciplinary presentation from Chicago group led by
@LaFaverMD
on telemedicine services for FND
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Everytime you hear someone complain of young people as snowflakes or selfish just remember they uncomplainingly sacrificed there own happiness to keep their grandparents alive from a virus they were at very low risk from
“Teenage boys were hit hardest by the Covid lockdowns, with their mental health failing to recover despite the return to normality, according to the most comprehensive academic study of its kind.”
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Our CODES trial mediation analysis paper now out. Bottom line seizure related avoidance is core target but probably not the whole story
.
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Not only does early intensive rehab improve outcomes but it saves money down the line in care costs- programmes pay for themselves- the more intense you go the more money you get back
People with moderate to severe brain injury may be left with a range of disabilities, including difficulties with mobility, employment, education and social interaction. A study has found early, intense rehabilitation helps recovery
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Heading in the right direction | Nature Reviews Neurology.
@WillStewNeuro
and I comment on the
@FootballAssoc
decision to ban heading for under 12s we are supportive of the move but advocate a global brain health approach for footballers
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@justin_garson
Anyone who thinks that psychiatry requires philosophical paradigms in irder to exist hasnt spent enough time in the Emergency Room
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@danielgoyal
Very true and clear summary. Also worth adding that in the main its the sames clinician and they can choose- extra session nhs or session paying more privately
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. Our new paper on CRPS. We argue its a functional disorder but that functional disorders have a significant biology
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Founding Members | FNDS. The list of founding members of the Functional Neurological Disorders Society grows steadily; an impressive multi- disciplinary array of talent. Interested in FND, do join us
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@JNNP_BMJ
Increasing evidence that FND are associated with grey matter changes. Whether this is causal, prior risk or compensatory response remains unclear; suspect the latter. What it does confirm is that FND is ‘a thing’
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Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study - Cabreira - European Journal of Neurology - Wiley Online Library. Excellent scoping at part of
@Veronicabreira
phd
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Delighted ro be a scottish orthopaedic meeting today to speak about functional overlay- fascinating looking at the kit: don’t get mecano at neuropsychiatry conferences
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Webinar Registration - Zoom. Still think FND is a diagnosis of exclusion. Not only are there positive clinical signs but increasingly laboratory confirmed diagnosis. Thursday’s fnd society webinar will tell all. Free to join register on society website
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This was a difficult decision but I think the right one
After continuous monitoring of the evolving situation with COVID-19, the FNDS leadership has made the decision to move the 4th International Conference to 2021.
Full update: .
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This Thursday’s
@FNDSociety
webinar is a Q & A session on functional movement disorders by the Toronto gurus Tony Lang & Sarah Lidstone - free but register on society website
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@OGdukeneurosurg
Missing second commonest cause- acute functional paralysis- clues onset building over minutes- preservation of reflexes facial weakness actually muscle spasm, often paraesthetic symptoms in affected limb, breathlessness, odd tingling in scalp
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