Functional Neurological Disorder - An Overview

What Is Functional Neurological Disorder?

Instead of a structural disease process like multiple sclerosis or stroke, a functional neurological disorder (FND) is a medical condition in which there is a problem with how the nervous system works and how the body and brain send and/or receive signals. A wide range of neurological symptoms, like weakness in the limbs or seizures, can be part of FND.

FND is a condition that falls somewhere between neurology and psychiatry. In patients with FND, conventional tests like MRI (magnetic resonance imaging), brain scans, and EEGs (electroencephalograms) typically show no abnormalities. Historically, clinicians and researchers alike have neglected the condition due to this. However, it is now known that FND is a frequent cause of disability and distress, which may overlap with other issues like fatigue and chronic pain. Positive research suggests that FND can be reversed with individualized treatments. The way FND patients are diagnosed and treated is influenced by new scientific findings, resulting in a shift in public perception.

Since the middle of the 2000s, beliefs that FND is "all psychological" and that the diagnosis is only made when tests are normal have changed. FND is not a diagnosis of exclusion, as the new understanding, including contemporary neuroscientific studies, has demonstrated. It has explicit clinical elements of its own and is a problem with the working of the sensory system, in which numerous points of view are important. These are extremely individual-specific. Psychological factors are important for some people but not for others.

What Are the Signs and Symptoms of a Functional Neurological Disorder?

Physical, sensory, and/or cognitive symptoms can manifest in a variety of ways in FND patients. The most typical are:

Motor Dysfunction:

• Weakness or paralysis of the functional limbs.

• Disorders of functional movement, including spasms (dystonia), tremors, jerky movements (myoclonus), and difficulty walking (gait disorder).

• Symptoms of functional speech; include slurred or stuttering speech and whispering speech (dysphonia).

Sensory Dysfunction:

• Alterations in sensation are examples of functional sensory disturbance, such as tingling, numbness, or pain in the face, torso, or limbs. This frequently happens on one side of the body.

• Symptoms of the visual system; include double vision and vision loss.

Episodes of Altered Awareness:

• Blackouts, fainting, and dissociative (non-epileptic) seizures: These symptoms can be similar to epileptic seizures or syncope (fainting).

The symptoms can change from day to day or be present constantly. Some FND patients may experience sudden relapses of symptoms after a significant or complete remission.

Other physical and mental side effects are regularly experienced by patients with FND, but they may not be available. These are some: anxiety and depression, chronic pain, fatigue, issues sleeping, memory, bowel and bladder symptoms, and other symptoms.

What Causes Functional Neurological Disorder?

The specific reason for FND is unknown, although the continuous examination is beginning to give ideas with regard to how and why it develops. Various inclining variables can make patients more helpless to FND. For example, having another neurological condition or experiencing chronic pain, weakness, or stress. However, not all of these risk factors exist in all FND patients.

Studies have demonstrated that a physical injury, an infectious illness, a panic attack, or a migraine can give someone their first experience of FND symptoms at the time they begin. In most cases, these symptoms go away on their own. However, the symptoms in the case of FND become "stuck" in a nervous system "pattern." Alterations in brain function are a reflection of that "pattern." The end result is a real, crippling issue over which the patient has no control. The goal of treatment is to "retrain the brain." For example, by relearning normal movement patterns and removing abnormal and dysfunctional patterns that have developed.

One perspective on FND is to view it as a piece of software, like a computer software issue. While the "hardware" is unharmed, the "software" is faulty, preventing the computer from functioning properly. Unless the patient has another neurological condition, conventional structural MRI brain scans are typically normal in FND. The brain malfunctions in FND and functional brain scans (fMRI) are beginning to provide preliminary evidence for this. fMRI examinations show changes in patients with FND that appear to be unique from healthy patients without these side effects and sound individuals 'pretending' to have these side effects. Functional imaging is, as yet, an exploration device and is not sufficiently developed to be utilized in the diagnosis of FND. Patients and researchers already know that these are real disorders in which the person with FND experiences a change in brain function that is out of their control. Scans support this.

FND has historically been viewed solely as a psychological condition in which repressed psychological stress or trauma is "converted" into a physical symptom. The term "conversion disorder" originates from this. Mental problems and unpleasant life-altering situations, both ongoing and in youth, might be risk factors for fostering the condition in certain patients, yet they seldom give a full clarification to the reason for the condition and are missing in numerous patients. FND can happen to anyone, regardless of whether they have been through a difficult childhood or are depressed, anxious, or both.

Present-day hypotheses suggest that FND has many causes, which differ from one patient to another. Consider heart disease as an example of the comparison. Heart disease can be brought on by a variety of factors, including smoking, genetics, diet, and even psychological or stress-related factors like depression. Although smoking may contribute to heart disease in some individuals, it is not always the case. FND can be used in the same way. When it is about understanding how the brain has gone wrong, certain psychological factors, such as past trauma or stress at the time of symptom onset in FND, are crucial. For some, the presence of a problem like a migraine or an injury may be the most significant factor.

How Is Functional Neurological Disorder Diagnosed?

FND is analyzed based on certain actual signs and typically requires a nervous system specialist or a specialist acquainted with a neurological diagnosis. These signs include the following:

• The patient may have find it difficult to push their "bad" leg down (hip extension) on the Hoover test, but when asked to lift their "good" leg, the movement in the "bad" leg returns briefly to normal.

• The tremor entrainment test for functional tremors is a test in which a person's arm or leg shaking improves for a brief period of time when they focus on imitating the examiner's movements.

• A trained medical professional can frequently identify dissociative (non-epileptic) seizures by using a combination of typical symptoms like hyperventilation during a shaking attack, tearfulness upon recovery, violent limb thrashing with the eyes closed, side-to-side head movements, or an event lasting more than five minutes with the eyes closed.

How Are Functional Neurological Disorders Treated?

FND can be difficult to comprehend, and a great many people do not know about it. Even though scan reports and other laboratory tests might be normal, treatment should begin with a clear and convincing explanation of the positive clinical features that allowed the diagnosis to be made.

Certain treatments, particularly physiotherapy for motor symptoms and cognitive behavioral therapy (CBT) for attacks or seizures, are beginning to be supported by evidence. For FND, specialized forms of CBT and physiotherapy have been developed. Depending on the symptoms, additional therapies like speech therapy and occupational therapy may also play a role.

• Physical Therapy: Physical therapy with a therapist who is familiar with FND can be beneficial for patients who have motor symptoms like limb weakness, gait issues, or movement disorders. Physiotherapy approaches are dynamic medicines that emphasize retraining development designs that have turned out badly. Clinical trials have shown that some patients may benefit from physiotherapy designed specifically for FND. We have learned in recent years that physical therapy for FND differs significantly from stroke or MS treatment. For instance, in patients with FND, focusing on the affected body part tends to make things worse, whereas in stroke patients, it helps. The abnormal brain patterns that have been preventing movement during FND physical therapy are reduced, and "automatic movements" are encouraged.

• Psychological Therapy: Clinical trials support CBT (cognitive behavioral therapy) as the first line of treatment for FND patients who experience dissociative (non-epileptic) seizures or attacks. Therapy includes time spent learning more about their attacks, recognizing brief warning signs, and acquiring control-regaining strategies. Examining more deeply the thoughts, feelings, and experiences that may have contributed to the onset of symptoms can be helpful for some patients. Psychological therapy may still be helpful in regaining confidence for patients who do not suffer from depression or anxiety. The condition of FND itself is frequently perceived as a stressful one to manage and live with. Depending on the individual patient, additional psychological therapies, such as psychodynamic, interpersonal therapy (PIT) or more trauma-focused work for patients who have experienced such events, may also be utilized.

• Occupational Therapy: Occupational therapy helps people find adaptations and regain confidence in their ability to do what they do every day at home or work. Occupational therapy can help improve the overall quality of life by building on other treatments.

• Speech Therapy: Speech therapy is an integral part of treatment for FND patients who have speech problems. The treatment approach for FND is different from that usually used, for example, after a stroke, like physical therapy, and patients benefit from seeing therapists who are experts in this field.

• Other Therapies: There is no research-based evidence to suggest that any particular medication is helpful for FND; however, medications may be helpful for other symptoms of FND, such as anxiety, pain, or migraines. In research studies, other treatments are being looked into. Not everyone with FND can find benefit from the treatment, even if they are aware of their condition and motivated.

Conclusion:

Functional neurological symptom disorder (FND), also known as conversion disorder, is a complicated condition that manifests itself as neurological symptoms despite the absence of any obvious structural issues in the nervous system. The specific reason is not clearly known. However, stress can be a significant factor. The duration and severity of the functional neurological disorder (FND) signs and symptoms vary from one individual to another. In most cases, the symptoms do not pose a threat to one's life; however, complications that do occur can make a person's life less enjoyable or debilitating. Many people with FND recover once they are assured that their symptoms are unrelated to a physical condition or serious illness