Citation

Phillips W. BMJ Neurol. Open 2021; 3(1): e000100.

Copyright

(Copyright © 2021, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1136/bmjno-2020-000100

PMID

34189462

Abstract

The structure of the expert report and the role of the expert witness are beyond the scope of this article. However, certain points are relevant when considering a claimant's functional symptoms. In the history section, it is useful to describe a typical day and the range of activities undertaken on both 'good' and 'bad' days; this is important in interpretation of video surveillance. It helps to include a brief vignette of the claimant's life, including any childhood adversity, if relevant--they may be more at risk of developing functional neurological disorder (FND), for example. It is worth asking the claimant what they feel about the accident; if they believe there is permanent damage done, they are less likely to improve and if they harbour grievance towards the 'perpetrator', they are more likely to develop post-traumatic symptoms.

In legal claims, and in clinical experience, claimants/patients with FND, and indeed with any neurological condition, may have a degree of volitional symptom control. This may be produced in order to gain relief from responsibilities, for example, or a more subconscious exaggeration to convince others of the patient's/claimant's suffering. At the other end of the spectrum is factitious disorder, a psychiatric condition, where patients willfully fabricate symptoms; and malingering, whereby symptoms are consciously fabricated for (usually material) gain. Given that, in FND, it will superficially appear the claimant's symptoms and signs are under voluntary control, it is not possible to be sure if that claimant is fabricating or not. However, there may be suggestions that the claimant is an unreliable witness; for example, prominent mismatch between reported and actual function (observed by covert surveillance, for example), markedly different histories given to different professionals (although physical examination findings may vary), or a microbiology report suggesting a wound may have been tampered with. Ultimately, reliability of a claimant is for the court, not the expert, to decide...

Language: en

Keywords

traumatic brain injury; concussion; functional neurological disorder