Functional neurological disorders (FND) are common and associated with significant morbidity and healthcare costs. Written by Prof. Markus Reuber, Neurologist, Sheffield, UK The information in NORD’s Rare Disease Database is for educational purposes only and is not intended to replace the advice of a physician or other qualified medical professional.The content of the website and databases of the National Organization for Rare Disorders (NORD) is copyrighted and may not be reproduced, copied, downloaded or disseminated, in any way, for any commercial or public purpose, without prior written authorization and approval from NORD.
In some people, psychological factors are important, in others they are not.FND patients can experience a wide range and combination of symptoms that are physical, sensory and/or cognitive. In the past, the brain of a patient with functional neurological symptom disorder was believed to be structurally normal, but functioning incorrectly. Know the causes, symptoms, treatment, risk factors and prognosis of Functional neurological symptom disorder. NORD gratefully acknowledges Jon Stone MB, ChB, PhD, Consultant Neurologist, Co-director Functional Disorders Research Group, University of Edinburgh, UK; Tim Nicholson, Honorary Consultant Neuropsychiatrist, South London & Maudsley NHS Foundation Trust and Kings College Hospital NHS Foundation Trust, London, Clinical Senior Lecturer in the Section of Cognitive Neuropsychiatry, Institute of Psychiatry Psychology & Neuroscience, King’s College London; and Bridget Mildon, President/CEO FND Hope, Inc., for the preparation of this report.Functional neurological disorder (FND) is a medical condition in which there is a problem with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process such as multiple sclerosis or stroke. J Neurol Neurosurg Psychiatry 2015;86:1113–9.Jordbru AA, Smedstad LM, Klungsøyr O, et al.
The Mass General Functional Neurological Disorders Clinic specializes in treating patients with motor neurological symptoms that lie at the intersection of neurology and psychiatry. In my case, I have severe muscle movements, often in response to stress and anxiety. Pain disorders are also usually associated with fatigue, sleep disturbance, and poor concentration. Other triggers may include changes or disruptions in how the brain functions at the structural, cellular or metabolic level. Scans support what patients and researchers already know – these are genuine disorders in which there is a change in brain functioning, which is out with the control of the person with FND.Historically, FND has traditionally been viewed as an entirely psychological disorder in which repressed psychological stress or trauma gets ‘converted’ into a physical symptom. Others, particularly those with recurrent attacks of symptoms that resemble epilepsy (dissociative seizures [DS]), may be frequent attenders, and often inappropriately loaded with antiepileptic or even anaesthetic drugs if misdiagnosed. Neurology 2010;74:1986–94.Non-Epileptic Attacks. However, the symptoms are real and cause significant distress or problems functioning.Signs and symptoms vary, depending on the type of functional neurologic disorder, and may include specific patterns. Written information, like that available at www.neurosymptoms.org or www.fndhope.org may help individuals comprehend this complex and difficult to understand disorder.Evidence is now emerging for the efficacy of certain treatments, especially physiotherapy for motor symptoms and a type of psychological therapy called cognitive behavioral therapy (CBT) for attacks or seizures. For example, in a cohort of people with dissociative seizures, 50% were regularly attending A&E.
With the development of hyperacute stroke services, patients with stroke-like presentations of FND commonly enter the acute stroke pathway: about 9% of admissions to hyperacute stroke units have FND.The two commonest presentations to acute settings are with seizure-like episodes or with persistent motor symptoms that resemble a stroke. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. Recently, that team also opened the door for Linda to receive treatment for an odd lump on her face. There are lots of causes of heart disease – smoking, genetic factors, diet and even stress-related / psychological factors such as depression. Functional neurological disorder (conversion disorder, FND) is one of the commonest diagnoses made in neurology clinics. However, it is now established that FND is a common cause of disability and distress, which may overlap with other problems such as chronic pain and fatigue. Symptoms can vary in severity and may come and go or be persistent.