What is functional neurological disorder?
Functional neurological disorder is a condition where there is a dysfunction in the nervous system that disrupts how the brain sends signals to the rest of the body. In this article consultant neuropsychiatrist Dr Daniela Riano Barros explains functional neurological disorder, how it can occur, and what possible treatments are available.
What is functional neurological disorder and what causes it?
Functional neurological disorder (FND) refers to a group of neurological symptoms that cannot be traced back to a certain structural abnormality in the brain and nervous system. MRIs or CT scans will not show any visible injury or disease (like a tumour) in the brain and nervous system – instead, it is theorised that the symptoms stem from disruption to the brain networks.
Those who are at a higher risk of developing FND include those who have coexisting physical or/and mental health conditions. There is no way to definitively avoid or prevent FND, as everyone has the potential to develop it and it can be triggered suddenly.
It used to be called ‘conversion disorder’, as it was thought that the symptoms were a physical manifestation of psychological illness and distress. Rather, it is more accepted today that psychological distress may be comorbid with FND, but not necessarily present.
What are the signs of functional neurological disorders?
The symptoms of FND include:
- Motor disruptions (such as weakness or paralysis, abnormal movements, muscle spasms, tremors, abnormal gait, and tics)
- Sensory disruptions (such as numbness, burning sensation, double vision, hearing loss)
- Difficulty swallowing or feeling as though there is an obstruction in the throat
- Speech problems (such as slurring, sudden hoarseness or unintentional mutism)
- Non-epileptic seizures or seizure-like episodes
- Brain fog, and memory issues
- Balance difficulty and dizziness
- Gastric and urinary symptoms (such as Incontinence).
It may also be accompanied by chronic pain and fatigue. The symptoms can have a sudden, unpredictable onset and may not constantly be present, thus barring patients from living their everyday lives.
How is functional neurological disorder diagnosed?
The symptoms of FND overlap with some other neurological conditions such as epilepsy, multiple sclerosis, dystonia, or Parkinson’s, which means that many patients may be under- or misdiagnosed.
Diagnosing FND requires a thorough review of the patient’s personal and familial medical history, a physical exam, and observation of the patient’s behaviour and mannerisms.
Some signs that can indicate FND to a specialist include alexithymia (difficulty describing own feelings), irregular distribution of symptoms (where they occur in the body), Hoover’s sign (inconsistency between automatic and voluntary hip extension), give way weakness (inconsistent muscle power).
Imaging tests may be utilised to rule out other neurological conditions or diseases, like MRIs, CT scans, or electroencephalograms.
How is functional neurological disorder treated?
It is important for doctors to acknowledge the veracity of the patient's experience with FND, so to treat FND, doctors have to take a multidisciplinary, patient-centred approach, combining aspects of medicinal, psychological, and physiological care to improve their quality of life.
- Psychoeducation such as understanding FND and triggers.
- Medications such as antidepressants, pain relief, and anti-anxiety medicine may be applicable.
- Neuropsychology for FND and psychological therapies for coexisting conditions.
- Physiotherapy and speech therapy can help the patient regain control of their muscles and restore functionality.
- Occupational therapy can help patients learn how to continue their daily activities and lives while grappling with FND.
With multidisciplinary care, a full recovery from FND is possible, or at the very least, a significant improvement of the symptoms.
If you are struggling with an unknown neurological disorder, you can consult with Dr Riano Barros via her Top Doctors profile.