Functional Neurological Disorders Explained

June 12, 2020

What is Functional Neurological Disorder?  

Functional Neurological Disorder (also known as FND) is a medical condition in which there’s a problem with the functioning of the nervous system and the ways in which the brain and the body send and receive signals.

In the past, FND was regarded as a psychological disorder, but now it is considered a genuine neurological disorder with a psychological component to it.

Is FND known by any other names?

Yes. Functional Neurological Disorder can also be known as:

  • Functional Neurological Symptom Disorder
  • Functional Movement Disorder
  • Conversion Disorder
  • Psychogenic Seizure/Movement Disorder
  • Dissociative Stages/Motor Disorder
  • Non-Epileptic Seizures

It is often just referred to as FND.

While these terms can encapsulate a range of different symptoms and experiences, they all essentially relate to a disorder of neurological and psychological effects.

Does FND encompass other neurological disorders?

No, those are separate conditions. However, they are connected in that conditions such as stroke or Parkinson’s Disease can result in someone experiencing FND.

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In most cases, FND is the result of an incident or trauma or is triggered by something such as chronic fatigue.

What are the symptoms of FND?

FND patients can experience a wide range of physical, sensory and/or cognitive symptoms.  The most common include:

  • motor dysfunction such as limb weaknesses or paralysis, tremor spasms, involuntary jerky movements or problems walking.
  • speech symptoms such as slowed speech or stuttering
  • sensory dysfunction including numbness, tingling or pain (usually on one side of the body), visual disturbances such as loss of vision and double vision.
  • episodes of altered awareness such as dissociative seizures, blackouts, feeling faint

Symptoms may appear in combination; they may be constant or may fluctuate from day to day.

What are the risk factors for FND?

The exact cause is unknown, however, research suggests there may be predisposing factors. For example, patients with another neurological condition such as Parkinson’s Disease or Multiple Sclerosis are more susceptible to FND.

It is also thought that there may be some triggering factors for FND, although it is important to note that these triggers are not present in all cases.

 Triggers may include:

  • Experiencing chronic pain, fatigue, or stress
  • Experiencing a physical injury or infectious disease
  • Experiencing a panic attack
  • Experiencing a migraine

A useful analogy to understand FND may be to consider it as like a software problem on a computer: the hardware itself is not damaged, but there is a problem with the software and so the computer doesn’t work properly.

What demographic is most affected by FND?

Interestingly, children under ten years old are usually unaffected. In those under fifty, women are more likely to be affected while over fifty FND is found in men and women in equal numbers.

Is FND related to other disorders?

It is common for FND to coexist with other illnesses. FND can have similar symptoms to many other conditions in neurological practice (such as Multiple Sclerosis, stroke, and epilepsy) and some patients have both a neurological disease diagnosis and FND.

How would someone have this diagnosed?

Until recently, FND diagnosis was challenging because it was sometimes mistakenly considered to be a psychological condition. (This was largely because it does not show up on MRIs and other imaging scans.)

Now, however, it is better understood and is diagnosed on the basis of positive physical signs.  FND can very easily be missed, and therefore needs to be assessed and diagnosed by a specialist doctor.

What early intervention options are there?

Treatment should start with a clear, supportive explanation of the positive clinical features that have allowed the diagnosis to be made even though scans and other laboratory tests may be normal.

From there, the treatment process would involve addressing existing weaknesses and developing a physical exercise plan. Exercise is important for people dealing with FND.

What weaknesses would someone with FND experience?

A person with FND may experience weakness in lower limbs or arms. A diagnosis of FND enables a patient to see that they have a genuine and relatively common condition, which has the potential for improvement over time.

In what ways will a Physiotherapist help someone with FND?

There are specialised Physiotherapy programs that have been developed specifically for people with FND. Rehabilitation is very important particularly for correcting movement patterns.

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Evidence is now emerging that demonstrates the efficacy of certain speech treatments, and especially physiotherapy for motor systems.

In addition to physical therapies, psychological therapy can be important as well, particularly in relation to managing seizures.

In what ways can an Occupational Therapist help?  

Occupational Therapists help people with day to day functionality. This may involve finding adaptations or supporting someone to feel confident carrying out the activities of daily living in the home or workplace.

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Occupational Therapists also help with supplying assistive technology to aid the rehabilitation process and help someone return to pre-diagnosis or premorbid activity levels.

Occupational Therapy works in conjunction with Physiotherapy to contribute to better overall quality of life for the patient.

How should this be approached from a holistic multidisciplinary aspect?

As with any disease, working within a multidisciplinary team of professionals is of prime importance when it comes to achieving the best possible results.

Looking holistically at the patient means considering what factors in their life are contributing to their current state. This may be looking at what medications they’re on, or what other health complications are playing a role in their overall wellness.  At Total Health Physio, we consider it very important to work together to achieve optimal outcomes for each and every patient.

Who can I turn to for help?

The team at Total Health Physio can support you with expert Physiotherapy and Occupational Therapy treatment. We can discuss your current situation and work with you to develop a plan to support your needs.

Do you like patients to have a referral from a GP when treating someone for FND?

Any additional information from a GP, specialist or other treating health professional is valuable in that it can help us to gain an understanding of the bigger picture. It can provide us with valuable information about what interventions have already been implemented.

Whether it’s from a report from a GP, specialist, OT or hospital it’s always beneficial to have that information.

Is FND a lifelong condition?

It is a lifelong condition, however, it can be overcome with treatment. Understanding the diagnosis, and implementing the right treatment plan, can go a long way in improving outcomes and overcoming the symptoms of FND.