《显而易见的隐藏：新闻中的功能性神经障碍》
Hiding in Plain Sight: Functional Neurological Disorders in the News.
机构信息
The Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany (Popkirov); the Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); the Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (Bloem); the Institute of Medical and Biomedical Education, St. George's University of London and Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust, London (Cock); the Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (Derry); the Department of Neurology, University of Otago, Christchurch, New Zealand (Duncan); the Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston (Dworetsky); the Institute of Molecular and Clinical Sciences, St. George's University of London (Edwards, Morgante); the Department of Neurology, Gardner Family Center for Parkinson Disease and Movement Disorders, University of Cincinnati (Espay); the Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Hallett); the Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto (Lang); Queen Elizabeth University Hospital, University of Glasgow, Glasgow, United Kingdom (Leach); the Mater Centre for Neurosciences and School of Medicine, University of Queensland, Brisbane, Australia (Lehn); the Institut de Neurosciences des Systèmes, INSERM, Aix-Marseille Université, Marseille, France; the Department of Clinical Neurophysiology, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France (McGonigal); the Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (Morgante); the Departments of Neurology and Psychiatry, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); the Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, United Kingdom (Reuber); the Institute of Psychiatry, Psychology and Neuroscience, Kings College London (Richardson); the Department of Neurology, Alan Richens Epilepsy Unit, University Hospital of Wales, Cardiff, United Kingdom (Smith); the HYGEIA Hospital, Athens, Greece (Stamelou); the Neurology Clinic, Philipps University Marburg, Marburg, Germany (Stamelou); the University of Athens, Greece (Stamelou); the Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Tijssen); the Neurology Unit, Movement Disorders Division, University of Verona, Verona, Italy (Tinazzi); and the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone).
出版信息
J Neuropsychiatry Clin Neurosci. 2019 Fall;31(4):361-367. doi: 10.1176/appi.neuropsych.19010025. Epub 2019 May 23.
OBJECTIVE
Functional movement and seizure disorders are still widely misunderstood and receive little public and academic attention. This is in stark contrast to their high prevalence and levels of associated disability. In an exploratory observational study, the authors examined whether the relative lack of media coverage of functional neurological disorders is in part due to misidentification in "human interest" news stories.
METHODS
Thirteen recent news stories from high-impact English-language media outlets that portrayed patients with complex symptoms either attributed to other diagnoses or presented as medical mysteries were identified using online keyword searches. All selected news stories contained video or still images displaying relevant symptoms. Cases were categorized into movement disorders or seizure disorders and were then independently assessed by 10 respective expert raters. For each category, one story of a patient whose symptoms were due to a well-recognized neurological disease was also included. Both the diagnostic category and the respective confidence level were reported by each rater for each case. The interrater agreement was calculated for each group of disorders.
RESULTS
The raters confirmed almost unanimously that all presented news stories except the negative control cases portrayed misidentified functional movement or seizure disorders. The interrater agreement and average diagnostic confidence were high.
CONCLUSIONS
Functional neurological disorders are often wrongly considered a rare medical curiosity of the past. However, these findings suggest that, while they are largely absent from public discourse, they often appear in the news incognito, hiding in plain sight.
目的
运动障碍和癫痫发作障碍仍然被广泛误解，很少受到公众和学术界的关注。这与它们的高患病率和相关残疾程度形成鲜明对比。在一项探索性观察研究中，作者研究了功能性神经障碍媒体报道相对较少的部分原因是否是由于“人文”新闻报道中的错误识别。
方法
使用在线关键字搜索，从高影响力的英语媒体中确定了 13 篇最近的新闻报道，这些报道描述了患有复杂症状的患者，这些症状归因于其他诊断或表现为医学之谜。所有选定的新闻报道都包含显示相关症状的视频或静态图像。病例分为运动障碍或癫痫发作障碍，然后由 10 名各自的专家评估员独立评估。对于每种类别，还包括了一个其症状是由公认的神经疾病引起的患者的案例。每个评估者都报告了每个病例的诊断类别和相应的置信水平。计算了每组疾病的组内评估者间一致性。
结果
评估者一致认为，除了阴性对照病例外，所有呈现的新闻报道都描绘了错误识别的功能性运动或癫痫发作障碍。组内评估者间一致性和平均诊断置信度均很高。
结论
功能性神经障碍过去常常被认为是罕见的医学好奇心。然而，这些发现表明，虽然它们在公众话语中基本缺失，但它们经常以不为人知的方式出现在新闻中，隐藏在众目睽睽之下。
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