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    The Nosologic Term “Conversive” Disorder Should Be Abandoned | American Journal of Neuroradiology  
    


















    


























    
  
  




    
    

  

      


    

      

  
  
  

    

  

    

  

                
    

      

  

    

  
      
  
  

    


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LetterLETTER

  
      

  
      
The Nosologic Term “Conversive” Disorder Should Be Abandoned
  
    	
D. A. Lizarazo and A. Guarnizo

  
    	
American Journal of Neuroradiology August 2022,  43 (8) E17; DOI: https://doi.org/10.3174/ajnr.A7504 

  
  
  



  


  
  



  
      
  
  

    
We found the article by Prodi et al1 on the usefulness of a multimodal CT protocol in the diagnosis of stroke mimics very interesting. Among the pathologies evaluated is the so-called “conversive disorder,” a disorder in which diagnostic imaging was not useful.
The nosologic term “conversive disorder” should be abandoned, and instead the term “functional neurologic disorder” (FND) should be used. Recent research has made it clear that FND is not a rule-out diagnosis but a rule-in diagnosis based on positive physical examination findings.2 The term conversive disorder implies a psychiatric disease and leads the treating physician to think that there is no structural brain alteration; therefore, there should be no alteration in the diagnostic images. In recent years, it has been established that these patients do have subtle alterations on MR imaging,3⇓-5 such as smaller volume of the thalamus,5 an increased cortical thickening in the premotor cortex,3 and an inverse association between somatoform dissociation and left caudal anterior cingulate cortical thickness.4
The emergence of FND as a brain disease with an organic substrate and probable structural alterations should lead us to change the paradigm of the mental-versus-organic dichotomy.
Footnotes
References
  1. 1.
    1. Prodi  E, 
    2. Danieli  L, 
    3. Manno  C, et al
    . Stroke mimics in the acute setting: role of multimodal CT protocol. AJNR Am J Neuroradiol 2022;43:216–22 doi:10.3174/ajnr.A7379 pmid:34969667
  2. 2.
    1. Aybek  S, 
    2. Perez  DL
    . Diagnosis and management of functional neurological disorder. BMJ 2022;376:064 doi:10.1136/bmj.o64 pmid:35074803
  3. 3.
    1. Aybek  S, 
    2. Nicholson  TR, 
    3. Draganski  B, et al
    . Grey matter changes in motor conversion disorder. J Neurol Neurosurg Psychiatry 2014;85:236–38 doi:10.1136/jnnp-2012-304158 pmid:23236016
  4. 4.
    1. Perez  DL, 
    2. Matin  N, 
    3. Williams  B, et al
    . Cortical thickness alterations linked to somatoform and psychological dissociation in functional neurological disorders. Hum Brain Mapp 2018;39:428–39 doi:10.1002/hbm.23853 pmid:29080235
  5. 5.
    1. Nicholson  TR, 
    2. Aybek  S, 
    3. Kempton  MJ, et al
    . A structural MRI study of motor conversion disorder: evidence of reduction in thalamic volume. J Neurol Neurosurg Psychiatry 2014;85:227–29 doi:10.1136/jnnp-2013-305012 pmid:24039028
  


  
  



  



    

  



  

                
    

      

  

    

  
      
  
  

    


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