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Objectives – The objectives of this study were to: (i) establish whether the spinocerebellar ataxia type 8 (SCA 8) expansion is associated with ataxia in Scotland; (ii) test the hypothesis that SCA 8 is associated with neuropsychological impairment; and (iii) review neuroradiological findings in SCA 8. Methods – The methods included: (i) measurement of SCA 8 expansion frequencies in ataxic patients and healthy controls; (ii) comprehensive neuropsychological assessment of patients with SCA 8 and matched controls, neuropsychiatric interview; and (iii) comparison of patient and matched control magnetic resonance imaging (MRI) scans. Results – (i) 10/694 (1.4%) unrelated individuals with ataxia had combined CTA/CTG repeat expansions >100 compared to 1/1190 (0.08%) healthy controls (P

Editor—The editorial by Baker et al highlights the nonsensical way in which psychiatric and neurological disorders and the doctors who look after them have been divided over the past 100 years and how modern neuroscience is bringing them closer together again.1-1 Where is the wall between the two specialties at its thickest? Not in academic research, where distinctions between mind and brain in schizophrenia, Parkinson's disease, and depression are already largely abandoned. Perhaps in training? It is true that opportunities for a neurologist to gain psychiatric skills (and a psychiatrist to gain neurological skills)—in the United Kingdom and United States anyway—are limited and the scope for improvement is huge. But generally a patient with Parkinson's disease who also has delusional disorder will receive attention and treatment. Similarly, psychiatrists continue to look for neurological disease in their patients much more often than they find it. The thickest part of the wall and the greatest challenge to these two disciplines is in the area of functional neurological symptoms or neurological symptoms unexplained by disease. Freud, cited in the article as a prototypical neuropsychiatrist, was initially a neurologist, but he abandoned the clinicopathological model to explain hysteria. It was this proposal that drove the greatest schism between mind and brain 100 years ago. Up to one third of all new neurology outpatients have symptoms such as dizziness, numbness, pain, weakness, and blackouts that are neither explained by disease nor “functional.” Neither neurology nor psychiatry is particularly interested in them, and basic neuroscience has made only embryonic inroads into their understanding. Important aspects of functional neurological symptoms, such as illness beliefs and the interaction of cultural factors, may forever remain outside the reach of the scanner. To break down the wall truly, neurology and psychiatry must not simply focus on those symptoms where biology has permitted dialogue. In the 19th century physicians of nervous disorders brought important social, psychological, and biological perspectives to the symptoms they observed. Let's hope in our rush to examine the brains of our patients we do not forget to listen to what they are saying.

“I was no longer an academic, a runner, a skier or a traveller. Essentially I became just a head. My body was gone: I was no longer a physical being.” This is how M R Gallagher, previously a diabetes researcher and triathlete from Tasmania, begins this account of her five-year experience of illness, cowritten with friend and nursing lecturer Denise Fassett. After an asthma attack and ten days in intensive care she found she was unable to move her arms and legs, had difficulty swallowing and continuing problems breathing. Tests did not reveal a cause and as she becomes more and more disabled, M R finds herself in the “medical wilderness of the psychosomatic”. There is no cure. Five years later she remains in a nursing home, wheelchair-bound, with poor vision and generalised pain. She is surrounded by and attached …

Objective: Functional movement disorders (FMDs) fall within the broader category called functional neurological symptom disorder (FNSD). New DSM-5 criteria for FNSD no longer require the presence of a 'psychological conflict' suggesting that some patients with FMD may not have obvious psychological comorbidity. We studied patients with FMD in comparison to patients with a neurblogical movement disorder (MD) and healthy controls (HC) to identify whether there is a subgroup of patients with FMD who have normal psychological test scores.Methods: We assessed self-rated measures of depression/anxiety (SCL-90), dissociation and personality disorder (PDQ-4) in patients attending neurological clinics and healthy controls. The proportion of patients scoring within normal ranges was determined, and the levels of somatic and psychological symptoms were compared between the three groups.Results: Among the FMD group, 39% (20/51) scored within the normal range for all measures compared to 38% (13/34) of MD subjects and 89% (47/53) of healthy controls. There were no differences in overall scores in the SCL-90 and PDQ-4 between FMD and MD patients. FMD patients also did not differ from controls on a self-rated measure of personality pathology.Conclusion: Our data show that a substantial proportion of patients with FMD score within the normal range in psychological questionnaires, lending some support to the new DSM-5 criteria. (C) 2015 Elsevier Inc. All rights reserved.

Functional neurological symptoms are common in neurology and general medical practice. Functional neurological symptoms refer to neurological symptoms, which are not explained by a defined disease. The most common are functional weakness and non-epileptic seizures. Psychiatric models have dominated the classification, aetiology and treatment, limiting the neurologist's role to making the diagnosis by excluding disease and pronouncing the symptoms to be psychogenic. In this review, we outline the possibility of a positive diagnostic process, which can be the first step of treatment.

Functional (psychogenic) motor symptoms are diagnosed on the basis of positive signs of inconsistency or incongruity with known neurologic disease. These signs, such as Hoover sign or tremor entrainment, are often regarded by neurologists as 'tricks of the trade,' to 'catch the patient out, ' and certainly not to be shared with them. In this reflective article, the authors suggest that showing the patient with functional motor symptoms their physical signs, if done in the right way, is actually one of the most useful things a neurologist can do for these patients in persuading them of the accuracy of their diagnosis and the potential reversibility of their symptoms.

Persistent postural-perceptual dizziness (PPPD) is a new diagnosis for functional chronic dizziness and included in the new International Classification of Diseases (ICD)-11. The new criteria are positive, specific and make it easier to identify and study functional chronic dizziness. PPPD is a condition triggered by vestibular-, neurological- or psychological conditions. This review examines the symptoms, pathophysiology and treatment of PPPD.