LeRoy neurological illness mystery–update 3–is it conversion disorder?

Since I last wrote about the group of individuals suffering from some neurological issues in LeRoy, NY (outside of Rochester), very little new information has come to light.  The junk science purveyors, such as the Age of Autism, is still trying to insinuate that vaccines have something to do with the “outbreak”, although they provide not one tiny bit of evidence supporting such a belief.

A few individuals still claim it is PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, but I am highly skeptical of physicians who self-promote their ideas outside of the standard peer-review process, and that a lot of reviews of the research into PANDAS has come out negative.  As I’ve mentioned before, a recent review of research in PANDAS came to this conclusion: “Despite continued research in the field, the relationship between GAS and specific neuropsychiatric disorders (PANDAS) remains elusive. It is possible that GAS infection may be but one of the many stressors that can exacerbate tic/Tourette’s or OCD in a subset of such patients.”  If there’s not even agreement that PANDAS exists, then a self-serving promotor of this particular diagnosis should be met with a high level of skepticism.  Even researchers who accept PANDAS as a legitimate diagnosis, such as Susan Swedo of the NIMH, are skeptical of such a diagnosis.

Some individuals have suggested a diagnosis of conversion disorder, which are “symptoms or deficits affecting voluntary motor or sensory function that suggest a neurologic or other general medical condition. Yet, following a thorough evaluation, which includes a detailed neurologic examination and appropriate laboratory and radiographic diagnostic tests, no neurologic explanation exists for the symptoms, or the examination findings are inconsistent with the complaint.”  Dr. Gregory Young of the New York State Department of Health told NBC News, “We have conclusively ruled out any form of infection or communicable disease and there’s no evidence of any environmental factor.’’

Dr. Ronald Pies, MD, in his blog post, “Hysteria” in LeRoy: A Skeptic’s View, has stated that “my colleague and CNN mental health expert, Dr. Charles Raison, recently reviewed this story in a thoughtful commentary. He concluded—quite reasonably—that ‘conversion disorder is a plausible explanation’ for the tics, verbal outbursts, and apparent seizures afflicting this group of 12 or more adolescent females.”  Dr. Pies also makes a thoughtful analysis of the diagnosis of conversion disorder, which explains “what it is”, but fails miserably at explaining “why” or what causes it.

Pies further opines, “whatever the ultimate cause or causes of conversion, it seems clear that this condition does not represent “malingering” or an attempt to deceive others. Unfortunately, individuals diagnosed with conversion symptoms are often written off as “crocks” or “fakers” and denied a thorough medical evaluation.”

Parsimony would lead us to conclude that the simplest diagnosis is the best, in this case, conversion disorder.  Whenever something like this cluster occurs, many individuals invent a complex diagnosis, some of them to further their own causes (see anti-vaccine lunatics).  As frustrating as it might be, conversion disorder may make sense, and that will help these individuals get the appropriate psychological and psychiatric help.

The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor

Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!

  • Tom

    Conversion disorder is poorly understood in the general community. The best comparison I have heard is comparing it to stage fright. Obviously the actor is not trying to be sick or faking his illness. It is real and his being sick can make others get sick as well. But if a doctor was brought in to find a diagnosis she would be lost to find any physical reason for the illness.

    • I agree, I think it’s one of those catch-all terms in psychiatry to cover a general set of symptoms. Unfortunately, psychiatry doesn’t have the diagnostic tools that other medical specialties have.

      I have a certain amount of skepticism about what’s happening in LeRoy. Without evidence of anything more substantial, everything from some toxicological issue to a scam are still open. I’m just going to beat up the pseudoscience as best as I can. The PANDAS diagnosis particularly annoys me, since there is still debate that it exists.