Functional Neurological Symptom Disorder
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Functional neurological symptoms can appear similar to symptoms of other neurological conditions such as Epilepsy, Stroke, Multiple Sclerosis, Parkinson’s Disease or Spine and Neuromuscular Diseases but they have different mechanisms. FNDs are thought to be due to a problem with how the brain and body send and receive signals rather than a structural disease process. The structure [hardware] of the nervous system is normal and has no damage, but the function [software] of it has changed, resulting in symptoms.
FNDs include symptoms such as:
Patients may experience one or many of these symptoms. Functional neurological symptoms are very common and are the second most common presenting symptoms in Neurologist clinics after headaches. For most individuals these symptoms are short-lived, but for others they can continue for months or years. The symptoms can also change with time. FNDs are not dangerous and never fatal.
The diagnosis is usually made by a neurologist following a description of your difficulties, a neurological examination and sometimes investigations such as CT/MRI scans. Specialists can often tell differences between functional neurological symptoms and other neurological conditions when described in detail and on neurological examination without resorting to tests. Results of investigations are often normal and usually do not show any evidence of disease.
Because all tests and investigations in individuals with FND such as CT scans or MRI scans and EEGs are normal, many people think that they are making up their symptoms or that their symptoms are ‘in their head’. However, Functional neurological symptoms are real and are not faked or produced intentionally, cause significant distress and difficulty with functioning and reduce quality of life similar to other neurological conditions.
Functional neurological symptoms are a complex problem. These disorders happen due to a reparable breakdown in communication between different areas of the mind-brain-body axis and hence are called neuropsychiatric disorders. However, there is still much that we do not understand about what goes wrong in the nervous system to cause functional neurological symptoms.
For most people, there are many different causes. Some examples are:
For many, symptoms of FND represent a physical reaction to internal/emotional problems. For many it is not possible to identify a particular reason why these symptoms have developed. This lack of a specific answer can cause feelings of confusion, anger, and anxiety and lead to doubts about the diagnosis.
When somebody has a diagnosis of FND they may frequently experience other symptoms alongside such as:
By the very nature of their origin, FND symptoms are largely reversible. After being given a clear diagnosis, some people improve and get better without the need for further help. For other people the functional neurological symptoms may be having a major impact on their lives, and they may need more help in recovery. Multidisciplinary care provided by a team consisting of a Neurologist, Psychiatrist, Psychologist and in some cases a Physiotherapist always works best for FNDs.
For most individuals with persisting FND, it is helpful to look more widely at thoughts, emotions and experiences that could have played a role in the development of symptoms or maybe maintaining the symptoms and try to modify them. This method of Psychotherapy called Cognitive Behaviour Therapy [CBT] has been shown to be beneficial in many patients with FND.
Some patients might benefit from medications to manage co-existent anxiety, depression or post-traumatic stress disorder along with psychotherapy. However, this may not be appropriate or necessary for all individuals with functional neurological symptoms.
For individuals with motor symptoms (such as weakness/paralysis, difficulty walking), physiotherapy is helpful.
Learning about FND is the first step to recovery. If patients have ongoing doubts about the diagnosis, this may cause continuing worry/frustration and get in the way of managing and improving their symptoms. Patients should help family and friends to understand their diagnosis. This will help them to stay calm when symptoms occur. Patients must learn to notice triggers and factors that may make their symptoms worse or better.
Understanding symptoms and how they affect you in different situations is important. This is different for each person with FND.
Patients with FND must know not to get into a “boom or bust cycle”. This means not overdoing it when they feel energetic, only to then crash They must learn how to pace themselves so as to avoid getting into this cycle.
Having a consistent bedtime routine and avoiding certain food, drinks and activities (such as using screens on phones or tablets) are known to improve your sleep.
Yoga and tai chi are meditation and gentle movement techniques that can help stretch muscles and improve wellbeing.
Stress negatively affects symptoms. Stress can focus your attention on symptoms making them worse or more noticeable. A number of techniques could be used to manage stress such as mindfulness, deep breathing, music and exercise.
