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What Is Functional Neurological Disorder?

Functional neurological disorder (FND) is a condition in which the nervous system does not function correctly, causing symptoms, but in the absence of any diagnosed disease or event, such as stroke. It is a problem with the way the brain sends and receives signals to the body. Also known as conversion disorder, it can cause a wide variety of symptoms that may cause distress and impede normal life function. It is a common diagnosis by neurologists, according to the Royal College of Physicians.

As Dr. Lenny Cohen described, “FND is a condition when one has symptoms yet does not have any organic brain disease to cause such symptoms. One of the most common examples would be pseudoseizures that recently was renamed to non-epileptogenic seizures.”

While the symptoms of FND are real and “not just in your head,” they often exist without any obvious medical explanation. Diagnostic tests like MRIs generally come back without abnormality, leading doctors, for many years, to classify the symptoms as psychological. It is now widely accepted that FND is a problem based in the functioning of the nervous system that can cause pain, distress and mobility issues.

To diagnose FND a physician may run a variety of tests. According to Dr. Cohen, “Even when a physician suspects FND they are still obligated to have a full neurological work up done to rule out other possible causes. [Tests] might include extensive blood work, MRIs, EEGs, etc. FND is considered to be diagnosis of exclusion.”

The cause of FND is not known but it may be triggered when there is trauma of a physical or psychological nature, stress, or another neurological disease present. Several risk factors have been identified including stress, mental health conditions, having a family member with FND, a history of abuse or neglect, and the presence of other neurological disorders like multiple sclerosis.

According to the National Organization for Rare Disorders FND can occur when there are neurological symptoms which, instead of resolving, become stuck in a pattern in the nervous system. This results in a change in the functioning of the brain and nervous system and produces symptoms that the patient is not able to control.

There are many symptoms of FND that may be continual or may appear and disappear. Symptoms can continue for some time and hinder an individual’s ability to perform typical functions. Symptoms of FND include:

  • Limb weakness or paralysis
  • Tremors or abnormal movement
  • Problems walking
  • Vision, hearing, or speech problems
  • Seizures or loss of consciousness
  • Dissociation
  • Problems with memory or concentration
  • Tingling or twitching
  • Fainting or blackouts
  • Fatigue or sleep problems
  • Anxiety or depression
  • Chronic pain
  • Bladder and bowel issues

Treatment for FND begins with reassuring the patient that their symptoms are real and that there are a variety of treatments available. For motor issues, physical therapy specifically designed for FND patients has been effective. For patients with seizures or other flares, cognitive behavioral therapy can identify events that bring on symptoms and retrain the brain to manage them. For many FND patients this therapy may be helpful in understanding and emotions and behaviors connected to symptoms or working through the stress of diagnosis.

In the case of trauma-related symptoms specialized therapies may be used. For patients experiencing speech issues speech therapy may be ordered, and occupational therapy may play a role in helping patients manage daily life and work.

A diagnosis of FND may feel confusing at first but there are supports and treatments available. For more information visit the Functional Neurological Disorder Society or FND Hope.

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