Let’s Talk FND.
Functional Neurological Disorder (FND), previously known as conversion disorder, is a complex medical condition where there's a problem with the functioning of the nervous system, leading to symptoms that cannot be explained by another neurological or medical condition. These symptoms are real and can significantly impact a person's life, but they do not align with typical patterns of recognized neurological diseases.
Symptoms of FND
Motor Symptoms: These can include weakness or paralysis of a limb, problems with movement coordination, or tremor. Patients might experience sudden, weak, or jerky movements, often described as similar to a "short circuit" in the nervous system.
Sensory Symptoms: Individuals might report numbness, tingling, or pain in various parts of the body. Sensory loss often does not follow a typical nerve distribution, which is a key diagnostic feature.
Seizures or Episodes: These are termed functional seizures or dissociative seizures, resembling epileptic seizures but without the electrical activity in the brain that typically accompanies epilepsy. They might involve shaking, collapse, or loss of consciousness.
Speech and Swallowing Difficulties: Some people might experience issues with speaking or swallowing, where words might come out slurred or the patient might have trouble initiating speech.
Causes
The exact cause of FND isn't fully understood, but it's generally accepted that it involves a complex interaction between the mind and body:
Psychological Stress or Trauma: Many cases are linked to emotional or psychological stress, past traumas, or ongoing psychological distress.
Neurological Factors: There might be a subtle alteration in how the brain processes and integrates information, leading to the disconnection between voluntary control and physical function.
Genetic Predisposition: There could be a genetic component making some individuals more susceptible.
Diagnosis
Clinical Assessment: A thorough examination by a neurologist to rule out other conditions.
Imaging and Tests: While MRI or EEG might be normal, they're used to exclude other diseases.
Positive Signs: Identifying signs like Hoover's sign for weakness, where the affected limb might show involuntary strength when related muscle groups are tested indirectly.
Treatment
Reassurance and Education: Understanding that symptoms are real but not indicative of a degenerative disease can alleviate anxiety.
Physical Therapy: Particularly useful for motor symptoms, helping to retrain movement patterns.
Psychotherapy: Cognitive Behavioral Therapy (CBT) or other forms can address underlying psychological issues or help with symptom management.
Medications: While there are no medications specifically for FND, symptomatic treatment for associated conditions like depression or anxiety can be beneficial.
Prognosis
The prognosis varies. Some improve significantly with early intervention, while others might experience chronic symptoms. The course can be influenced by psychological support, stress management, and the individual's understanding and acceptance of their condition.
FND challenges the traditional mind-body dichotomy, illustrating how intertwined our psychological and physical health can be. It requires a holistic approach, combining medical, psychological, and rehabilitative strategies to manage and potentially improve the quality of life for those affected.
References
Stone, J., & Carson, A. (2013). Functional neurologic disorders. Continuum: Lifelong Learning in Neurology, 19(3), 598-614.
Edwards, M. J., & Stone, J. (2014). Diagnosis and management of functional neurological disorders. The Lancet Neurology, 13(10), 1064-1078.
Nielsen, G., Stone, J., & Edwards, M. J. (2015). Physiotherapy for functional (psychogenic) motor symptoms: A systematic review. Journal of Psychosomatic Research, 79(2), 91-102.
Carson, A., Lehn, A., Ludwig, L., & Stone, J. (2016). Explaining functional disorders in the neurology clinic: A photo story. Practical Neurology, 16(1), 48-54.