Functional Neurological Disorder

FND is a new term to the medical industry. In other words, it is also known as Conversion Disorder. Sounds complicated, doesn’t it? However, if you are reading about FND for the first time, you may feel overwhelmed. Because much of the information online is complex and aimed at people with medical knowledge. Let us break it down. This article aims to give you a simple and straightforward understanding of FND.

 

 

What is Functional Neurological Disorder?

First things first, FND (Conversion Disorder) is a condition in which a person has a series of physical symptoms without a clear illness or injury. For example, imagine you fall over. Afterwards, you can’t move your legs. But your legs aren’t injured. Neither is the rest of your body. Yet still, your symptoms are real, and you physically can’t move your legs. This example is the basis for the term Conversion Disorder. Your body translates your emotional and psychological trauma from the fall into physical symptoms. You cannot control these symptoms, and it can be scary. Following years of research, medical experts have incorporated Conversion Disorder under the broader umbrella of FND. As a result, it now includes the range of physical symptoms and responses that may occur. FND is unique in that it involves a combination of physical, psychological, and social influences. To this day, it is still considered a mysterious disorder. The onset of symptoms can often be confused with various common neurological disorders, and it requires a specialist with experience in treating the disorder. FND is considered a mental health disorder. There is an overlap of neurological and psychological symptoms that varies from person to person. Here at Epsychiatry, we can discuss a tailored treatment plan to help explore your specific causes of FND.

 

Can anyone get a Functional Neurological Disorder?

The exact cause of FND is unknown. However, extensive research is only starting to provide evidence on how and why people develop FND.

For instance, there are several contributing factors:

  • Biological
  • Psychological
  • Social

These factors can make the brain weak, trigger symptoms and prevent them from getting better. Physical trauma and pain can be common triggers. A previous mental health disorder, such as anxiety and depression, can also make a person vulnerable to FND. However, the experience differs for each person, and not everyone diagnosed with FND has a mental health disorder or traumatic life experience. People with FND may experience similar symptoms to those with Epilepsy, Parkinson’s, and Strokes. In addition, with FND, the symptoms are not the result of a known disease. Instead, they the result of a problem with the “function” of the body’s nervous system. Above all, our nervous system is the way our body sends internal messages. Its purpose is to control our voluntary and involuntary movements. Think of it as the body’s interior electrical wiring. The brain uses the wiring to send a message to the hand so that you can pick something up. You can see how a disorder of the nervous system can massively impact lives. To answer your question: Yes, as it stands today, anyone can get FND.

 

 

What are the signs and symptoms of Functional Neurological Disorder?

As FND varies so much with each person, there is an extensive range of symptoms. Meanwhile, the symptoms typically come on suddenly and are involuntary. But, they can last days or weeks and will likely resolve on their own. Symptoms can be devastating and have a lasting impact on the person.

Signs and symptoms include:

  • Loss of consciousness or unresponsiveness
  • Weakness in the limbs or paralysis
  • “Non-Epileptic” Seizures also called Dissociative attacks
  • Difficulty swallowing
  • Difficult and slurred speech
  • Chronic or unexplained pain
  • Body tremors and muscle contractions
  • Difficulty walking and loss of balance
  • Vision problems such as tunnel vision and blindness
  • Sensory issues such as loss of smell, touch, or hearing

A person with FND may not have all these symptoms or may have others. However, your psychologist at Epsychiatry can discuss with you the symptoms you may be unaware of. 

 

 

How is Functional Neurological Disorder diagnosed?

The real question on everyone’s mind is: how do you find out if you have FND?

Certainly, once you arrange to meet your doctor, you will need to provide a complete and accurate medical history. However, there should be both a physical exam and a psychological exam. In addition, the doctor may ask about stressors or significant changes in your life that could be contributing to your symptoms. They may consult the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to assess if you meet the criteria for diagnosis. Further, they will ask you to describe what you think may be wrong and will go through the plan of investigations and treatments. Experts once considered FND to be a diagnosis of exclusion. After that, doctors had to run extensive testing to rule out all other illnesses. Testing took significant time and was challenging for both doctor and patient. Misdiagnosis was frequent, and it was common for doctors to accuse patients of faking symptoms. Doctors can now diagnose FND through positive findings. They will examine the patient for evidence of physical symptoms that respond to FND. Doctors have noted that symptoms such as muscle jerking or tremors can resolve with distractions. This exercise is called the entrainment test.

 

 

Hoover Test

Another concrete test is Hoover’s test, also called Hoover’s sign. Doctors use this to test if one-sided leg weakness is organic or FND related. The patient will lie on a flat surface. The doctor will place one hand under each heel. They will then ask the patient to raise their “weak” leg in the air. This action should be difficult. The doctor will then ask them to lift their “good” leg. When the patient lifts their good leg, the effort will cause the weak leg to apply downward pressure against the doctor’s hand. In other words, though the person’s symptom is involuntary, their body’s automatic reactions are still intact. The response indicates that the weakness is not caused by a structured neurological condition, like a stroke. It can also help to understand what is causing the symptom and how to treat it. Hoover’s test is recognised to be 63% sensitive and 100% specific* [1][2] to an FND diagnosis. The diagnosis of FND does remain difficult. Patients may need to see both a neurologist and a psychologist. They may undergo imaging tests such as an MRI to rule out other disorders. The diagnosis can take significant time and patience. A practical assessment by our experienced psychologists here at Epsychiatry can help ease the stress of the process. 

 

 

What are the barriers to the diagnosis and treatment of Functional Neurological Disorder?

As with any problematic diagnosis, some barriers prevent people from seeking effective treatment. Some obstacles reported*[3] are:

  • Fear of not being believed about their symptoms
  • Feeling that some symptoms were dismissed or not taken seriously
  • Thinking the doctor would prefer to find a psychological cause
  • Believing they didn’t have adequate time to discuss their issues
     

 

What are the treatments for Functional Neurological Disorder?

Treatment depends on the presenting symptoms of the patient. Although there is no “magic pill” for FND, you can retrain the brain. You may need to try a combination of therapies. The best treatment plan comes from a teamwork approach, with input from a neurologist, psychiatrist, psychologist, and allied health professionals.

 

Prescribed Medications

Medication is not the typical treatment for FND. Studies have shown that prescribed medications have little to no effect on the symptoms. Medications do, however, manage the symptoms of depression and anxiety that may be associated with your FND. Serotonin reuptake inhibitors are a common type of medication used to cope with these co-morbidities. Speak to your doctor to find out the best course of treatment for your specific symptoms.

 

Physical Therapy

Depending on your symptoms, you may require physiotherapy input. Physical therapy incorporates movement therapy and daily exercises to help improve your symptoms. If you have paralysis or weakness of the limbs, this can positively benefit your ability to function. Treatment can be complex, and consistent effort is required for it to be effective.

 

Speech and Language Therapy (SLT)

If your symptoms include speech deficits or difficulty swallowing, you may benefit from SLT. SLT involves tailored therapy to combat your communication and swallowing issues. Your therapist can help you come to terms with the limitations of your symptoms and teach you practical exercises to treat them. A speech and language therapist works closely with the rest of your treatment team to ensure you feel your treatment is beneficial.

 

Psychological Therapy

The Mater Centre for Neurosciences Brisbane [4] reports that one-third of FND patients have another psychiatric condition. Many are vulnerable to depression and anxiety from a traumatic life experience, leading to FND. Others feel depressed because of their FND symptoms. Traditional talk therapy plays a crucial role in understanding the cause of a person’s FND. It can also help find the best course of treatment suited to the individual.

 

Cognitive Behavioural Therapy (CBT)

CBT is helpful in treating FND. It involves identifying the root cause of thoughts and behaviours that are associated with your symptoms. The aim is to break the negative thought-behaviour cycle and therefore relieve your FND symptoms. This therapy is results-driven and takes place over an agreed period. However, it can take weeks or months, depending on the patient’s symptoms. In the initial session, your psychologist will guide you to list your goals and set the course of treatment. As a result, throughout the therapy, you will seek to reach small achievable targets and given practical advice.

At Epsychiatry, our team have years of experience in delivering CBT. Get in touch today to start your treatment. 

 

 

The perception of for Functional Neurological Disorder

Unfortunately, there have been negative perceptions of FND in the past. That is to say, most patients were faking their symptoms to gain attention. According to the Mater Centre for Neurosciences [4], patients known to fake such symptoms account for only 5% of patients presenting with FND to the hospital.

Indicators that a patient may not be truthful [5] are:

  • A medical history inconsistent with their records
  • The patient has a history of being dishonest about medical issues
  • Direct confession from the patient
  • Avoiding diagnostic tests
  • Inconsistency between reported symptoms and the symptoms observed

Patients faking symptoms is a severe offence and can act as a further barrier to those who are suffering. It has led to a wrongful diagnosis of “hysteria” in many cases. As a result, this stigmatisation of FND means that many won’t seek the treatment they require. 

 

 

What is the outlook of Functional Neurological Disorder?

For some people, the symptoms of FND can be manageable. But for others, it can result in a solid disability. Regardless, this disorder has long-lasting effects on a person’s quality of life. The road may be long, but there have been many positive outcomes from focused and effective therapy treatments. Certainly, it is vital to know that FND is reversible. Contact Epsychiatry to start your consultation and the road to better treatment. Our psychologists and psychiatrists are currently talking referrals.

 

References

[1] McWhirter, L. et al. (2011) “Hoover’s sign for the diagnosis of functional weakness: a prospective unblinded cohort study in patients with suspected stroke.” Journal of psychosomatic research.

[2] Mehndiratta, M. et al. (2014) Hoover’s sign: Clinical relevance in Neurology. Journal of Postgraduate Medicine.

[3] Stone. J. (2015). Functional neurological disorders: the neurological assessment as treatment. Practice Neurology Doi:10.1136/practneurol-2015-001241

[4] Mater Centre for Neurosciences. Functional Neurological Disorder (FND) Learning Guide. Available online at: <https://fndaustralia.com.au/resources/FND-Learning-guide-for-nurses.pdf>

[5] Stone. J. (2009). Functional symptoms in neurology. Neurology in practice. Doi: 10.1136/jnnp.2009.177204