From the Guidelines
Functional Neurological Disorder (FND) is a medical condition where patients experience neurological symptoms that cannot be explained by traditional neurological diseases or structural abnormalities in the brain, and it is diagnosed by a neurologist using ‘positive clinical signs’ 1. These symptoms are real and not imagined or fabricated, despite normal test results like MRIs or EEGs.
Common Symptoms of FND
- Tremors
- Weakness
- Paralysis
- Abnormal movements
- Seizures
- Sensory changes
- Speech problems
- Cognitive difficulties FND develops when the brain's normal functioning is disrupted, often triggered by physical injury, emotional trauma, or stress, though many patients have no identifiable trigger.
Treatment Approach for FND
Treatment typically involves a multidisciplinary approach including:
- Physical therapy
- Occupational therapy
- Psychological therapy (particularly cognitive behavioral therapy)
- Sometimes medications to manage specific symptoms like anxiety or depression Unlike many neurological conditions, FND has the potential for significant improvement or recovery with proper treatment, especially when diagnosed early.
Key Aspects of FND Management
- Education about the condition is an essential part of treatment
- The disorder is not "all in the patient's head" but represents a genuine disconnect between the brain's control systems and bodily functions
- Speech and language therapy for FND should address illness beliefs, self-directed attention, and abnormal movement patterns through a process of education, symptomatic treatment, and cognitive behavioral therapy within a supportive therapeutic environment 1
- Occupational therapy treatment for FND is based on a biopsychosocial aetiological framework, with education, rehabilitation within functional activity, and the use of taught self-management strategies being central to occupational therapy intervention for FND 1
From the Research
Definition and Characteristics of Functional Neurological Disorder (FND)
- Functional Neurological Disorder (FND) is a condition characterized by neurological symptoms that lack an identifiable organic cause 2, 3, 4, 5.
- These symptoms can include motor, sensory, or cognitive disturbances, and are not deliberately produced 3.
- FND is also known as conversion disorder, and its diagnosis is predicated on clinical evaluation and the exclusion of other medical or psychiatric conditions 3, 4.
Diagnosis and Diagnostic Challenges
- The diagnosis of FND should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures 4.
- Recent advances in neuroimaging have shed new light on this disorder, and have the potential to predict treatment response 3.
- The diagnosis of FND can be challenging due to its phenotypic heterogeneity, and the need to differentiate it from feigning or malingering 3.
Treatment and Management
- Treatment of FND typically involves a multidisciplinary approach, addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions 3, 4, 5.
- Rehabilitative interventions, such as physical and occupational therapy, are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence-based treatment across FND subtypes 2.
- Tailored multidisciplinary treatment can involve physical and psychological therapy approaches, and evidence supports the use of combined treatment approaches 5.
Epidemiology and Pathophysiology
- FND is a common presentation in emergency and acute medical settings, and can cause severe disability in some individuals 2, 4.
- Psychological stressors are common risk factors for FND, but are often absent 5.
- The pathophysiology of FND includes overactivity of the limbic system, the development of an internal symptom model, and dysfunction of brain networks that gives movement the sense of voluntariness 5.