Functional neurological disorder (FND)

About

Functional neurological disorder (FND) is a type of neurological disorder characterized by neurological symptoms such as physical movement disorders, neuropsychological impairments and sensory disturbances that are not caused by physical damage to the brain or body. FNDs include a range of symptoms and can affect any area of the nervous system. Symptoms may be experienced as uncontrollable body movements, such as seizures and tremors, cognitive impairments, such as memory problems and confusion, and sensory disturbances, such as numbness and tingling. FND is typically treated with a combination of medications, physical therapy, psychological therapy, and lifestyle changes.

Symptoms

The symptoms of Functional Neurological Disorder (FND) can vary widely, depending on the type and severity of the disorder. Common symptoms include:

Episodes of weakness or paralysis in one or more part of the body
Abnormal postures or movements of the body
Seizures
Changes in sensation or perception
Balance or coordination problems
Visual disturbances, such as double vision or blurred vision
Speech disturbances, such as slurred speech
Difficulty in understanding language or speaking
Loss of sensation in the limbs
Memory problems
Lack of awareness of certain body parts
Abnormal sensation of bodily movement, such as feeling as if one’s limbs are floating
Difficulty in making decisions or concentrating
Anxiety or depression

Causes

The exact causes of Functional Neurological Disorder (FND) are unknown, however, a few possible causes have been suggested. These include a combination of biological, psychological and social factors.

Biological factors could include genetic predisposition, inflammatory triggers, metabolic dysfunction, autoimmune dysfunction, mitochondrial dysfunction, trauma and other physical ailments.

Psychological factors could include stress, anxiety, trauma, childhood maltreatment, depression, and post-traumatic stress disorder.

Social factors could include poverty, social isolation, and the social stigma attached to having a disorder.

Ultimately, the causes of FND remain unknown, but research into the disorder continues.

Risk factors

The exact cause of Functional Neurological Disorder (FND) is still unknown and there is no single risk factor associated with it.

However, there are a number of factors which have been linked to FND, both physical and psychological, which can increase an individual’s risk of developing the condition.

These risk factors include:

Previous physical or psychological illness: Previous diagnosis of a physical or psychological illness, such as depression, a brain injury, or a chronic health condition, can increase an individual’s risk of developing FND.
Genetics: Genes inherited from a person’s parents can increase their risk of developing FND. Such genetic factors may include a family history of FND, or a genetic susceptibility to other neurological disorders.
Age: While FND can affect people of all ages, it is most likely to occur in adolescents and young adults.
Gender: Women are more likely to develop FND than men.
Stress: Prolonged periods of stress, anxiety or depression can increase the risk of developing FND.
Lack of sleep: Insufficient sleep has been associated with an increased risk of developing FND.
Medication: Side effects of certain medications, such as tranquilizers or anticonvulsants, may increase the risk of FND.

Diagnosis

Functional neurological disorder (FND) is typically diagnosed by a multidisciplinary team of health professionals, including neurologists, psychologists, psychiatrists, and physical therapists. The diagnosis is usually based on a combination of subjective description of symptoms, medical history, physical and neurological exams, as well as imaging tests such as MRI and CT. In order to diagnose FND, the healthcare team must rule out any other medical condition that could be causing the symptoms. In some cases, a lumbar puncture may be used to rule out infections or other neurological disorders. Other tests such as electroencephalography (EEG) can also be performed to diagnose FND. A diagnosis of FND is made primarily based on the patient’s symptoms and the absence of further neurological or medical abnormalities.

Sub-types

Functional neurological disorder (FND) is a disorder characterized by neurological symptoms that cannot be explained by a structural or physiological cause, and is believed to arise from the interactions of psychological, social and environmental factors.

The various subtypes of FND include:

Psychogenic non-epileptic seizures (PNES): Characterized by recurrent seizures, often accompanied by loss of consciousness, that are not caused by seizures from a neurological dysfunction.
Conversion disorder: Characterized by physical symptoms such as paralysis, blindness, or sensory deficits with no identifiable neurological cause.
Functional dystonia: Characterized by involuntary repetitive and sustained muscle contractions, resulting in abnormal posturing.
Functional tremor: Characterized by involuntary, rhythmic back-and-forth or shaking movements of body parts that are not due to neurological conditions.
Functional gait disorder: Characterized by walking difficulties not related to a neurological cause.
Functional sensory symptoms: Characterized by sensory disturbances such as tingling, numbness, or burning of body parts.
Functional vision symptoms: Characterized by vision disturbances such as perceptual distortions or blurring of vision.
Functional movement disorder: Characterized by abnormal movement of body parts that is not related to any neurological condition.

Treatments

Treating functional neurological disorder (FND) requires an individualized approach and is best managed by an experienced neurologist or movement disorder specialist. Treatment commonly includes a multi-disciplinary team, including physical and occupational therapists, psychologists, psychiatrists, and neurologists.

Common treatments for FND include physical therapy, speech therapy, occupational therapy, cognitive behavioral therapy, medications, and lifestyle changes.

Physical therapy can help improve mobility, balance, gait, and coordination. It also helps to develop compensatory strategies and coping techniques to maintain function or relearn skills that have been forgotten or lost due to FND.

Occupational therapy helps patients regain the ability to perform everyday activities and helps to modify activities to accommodate any difficulties due to FND. Speech therapy helps to reduce speech and language deficits that may be present.

Cognitive behavioral therapy (CBT) is used to treat the underlying psychological factors that may be causing the disorder, by helping the patient identify and manage their thoughts and feelings.

Medications are occasionally used to help improve the symptoms of FND. This may include antidepressants, anticonvulsants, or muscle relaxants.

Lifestyle changes such as reducing stress, getting enough sleep, and increasing physical activity can also help improve symptoms of FND.

Prevention

Exercise regularly: Regular exercise has been shown to decrease the risk of developing FND by improving overall physical and mental health.
Seek medical attention: If you experience any signs and symptoms of a functional neurological disorder such as changes in movement, sensation, or coordination, seek medical advice as soon as possible.
Get adequate sleep: Adequate sleep helps to reduce stress, which has been linked to FND. Aim for 7 to 8 hours of quality sleep per night.
Practice relaxation techniques: Many relaxation techniques have been shown to reduce stress and anxiety, which can reduce the risk of developing FND. These include mindfulness meditation, progressive muscle relaxation, deep breathing, and guided imagery.
Eat a healthy diet: Eating a healthy, balanced diet can help to reduce the risk of FND by providing the body with the nutrients it needs.
Reduce exposure to triggers: Try to identify and reduce exposure to any triggers that may have previously caused or worsened FND symptoms. This may include stress, certain medications, and physical or emotional trauma.

Gender differences?

Yes, there are gender-specific differences in the presentation and management of Functional Neurological Disorder (FND). Several studies have found that women are more likely to present with FND than men and are more likely to receive psychotherapy and medications. Women are also more likely to suffer from more severe symptoms, such as motor deficits and cognitive impairments. In terms of management, women are more likely to receive a combination of physical and psychological interventions, while men are more likely to receive pharmacotherapy. Additionally, women are more likely to experience a higher degree of psychological distress and anxiety. Finally, women are more likely to report greater disability and disability-associated distress than men.

Nutrition

Nutrition plays a key role in the management of Functional neurological disorder (FND). A healthy diet, rich in fruits, vegetables, whole grains, and lean proteins, is essential for optimal brain and physical health and can help reduce FND symptoms and flare-ups. Additionally, avoiding certain food sensitivities and eating regular meals can help maximise energy levels and minimise stress and anxiety, which can also help manage symptoms. Nutrients, such as vitamin B and omega-3 fatty acids, which are known to support neurological health, are also important for FND management. Therefore, eating a balanced, nutrient-dense diet, tailored to individual food sensitivities, can significantly help to improve quality of life and reduce symptoms.

Physical Activity

Physical activity can have a positive effect on Functional Neurological Disorder (FND). Research has found that physical activity can reduce muscle tension and fatigue, as well as improve quality of life, physical and psychological functioning, and overall well-being in FND patients. Physical activity has also been linked to improvements in the brain’s neural networks, which can help reduce the symptoms associated with FND. Regular physical activity, such as aerobic and strength training, can help with fatigue, balance, coordination, and sleep. Additionally, physical activity can help FND patients learn to better manage their pain and stress, reduce anxiety and depression, and improve cognitive functioning. In summary, physical activity can be an effective way to manage the symptoms of FND and improve overall physical and mental health.