From the Guidelines
Functional Neurological Disorder (FND) can indeed cause a patient to become unresponsive with a Glasgow Coma Scale (GCS) score of 3, exhibit hypoxemia, and remain unresponsive to painful stimuli, such as deep sternal rubs, due to the brain's remarkable control over bodily functions and the disconnect between brain pathways that can produce genuine physical symptoms without structural damage. The symptoms of FND can be diverse and include weakness, movement disorders, sensory symptoms, cognitive deficits, and seizure-like events, as well as fatigue and persistent pain, which can present acutely and resolve quickly or can be long lasting 1. For a patient presenting with such symptoms, a multidisciplinary approach including neurology, psychiatry, and psychology is recommended, with treatment focusing on explaining the diagnosis positively as a problem with brain functioning rather than labeling it as "psychiatric" 1. Key aspects of management include:
- Cognitive behavioral therapy specifically designed for FND as the first-line treatment
- Physical therapy for any movement symptoms
- Antidepressants like sertraline or duloxetine for comorbid anxiety or depression
- Avoiding unnecessary medical interventions during acute episodes to prevent reinforcing the disorder It is essential to acknowledge the reality of the symptoms while providing a clear explanation of the diagnosis for therapeutic success, recognizing that patients with FND genuinely experience these symptoms and cannot simply "snap out of it" 1.
From the Research
Functional Neurological Disorder (FND) Symptoms
- FND is a common cause of persistent and disabling neurological symptoms 2
- Symptoms can include functional weakness, seizures, and other movement disorders 3, 4
- FND can cause severe disability in some individuals, but early diagnosis and treatment can promote recovery 4
Diagnosis and Treatment of FND
- FND is now a "rule-in" diagnosis based on validated neurological examination signs and semiological features 5
- Diagnosis can be made using a comprehensive neurological evaluation, and physical and occupational therapy may be useful adjunct assessments 5
- Treatments for FND include rehabilitative interventions (physical and occupational therapy) and psychotherapy 2, 4
- A multidisciplinary approach to treatment is recommended, with a focus on patient-centered care and individualized treatment plans 6, 3
FND and Unresponsiveness
- There is no direct evidence in the provided studies to suggest that FND can cause a patient to become unresponsive with a Glasgow Coma Scale (GCS) score of 3, exhibit hypoxemia, and remain unresponsive to painful stimuli, such as deep sternal rubs
- FND presentations, such as functional weakness and seizures, require tailored interventions with early involvement of physiotherapy and/or psychological support 3
- However, it is possible that patients with FND may exhibit severe symptoms that require emergency department evaluation and management 5