Neurologic clinics
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The widespread use of video-electroencephalogram monitoring has dramatically increased our recognition of the high prevalence and diversity of nonepileptic seizures. Nonepileptic seizures stand squarely in the interface between psychiatry and neurology, an area that has been both claimed and denied by both sides. Collaborative exploration of this border zone has provided new insights into a disorder that may be as ancient as epilepsy.
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Reflex sympathetic dystrophy (RSD) and causalgia appear to reflect identical pictures even though the latter is related to nerve injury and the former is not. Overriding past and present skepticism about a role for the sympathetic system in their cause and treatment, the International Association for the Study of Pain still recommends sympathetic blocks and sympathectomy for both causalgia and RSD. Such fallacy is traceable to fragmentary clinical observations, to ad-hoc experiments, and to traditional neglect of the placebo phenomenon in chronic "neuropathic" pain patients.
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Factitious disorders including Munchausen's syndrome are likely encountered by all clinicians during their career. Neurologic presentations are common, especially with Munchausen's syndrome by proxy. ⋯ Underlying psychiatric syndromes need to be assiduously evaluated and steadfastly treated. Prognosis is best for patients who do not meet criteria for Munchausen's syndrome or who have psychosocial supports and less severe personality pathology.