Functional Neurologic Disorder (FND)

What is Functional Neurologic Disorder?

• FND is a neurological condition caused by functional changes in the brain's networks, not structural changes.
• Symptoms are genuine but not attributable to structural brain changes; the exact cause is unknown.

Symptoms:

• Seizure-like episodes

• Movement problems

• Cognitive function issues

• Dizziness

• Speech difficulties (stuttering, trouble speaking)

• Vision or hearing problems

• Pain (including chronic migraines)

• Extreme slowness, fatigue

• Numbness or inability to sense touch

• Symptoms interfere with daily life but are not intentionally produced.

• Symptoms may appear suddenly, worsen with attention, and decrease with distraction.

Diagnosis:

• Brain imaging (MRI, CT scans) and other neurological tests often appear normal.
• Functional neuroimaging and neurophysiology show changes in brain connections.
• FND involves impaired signal transmission and sense of agency.
• Increased activity in the limbic system affects emotion regulation and stress response.

Types of FND:

1. Functional/Dissociative Seizures:

   • Seizure-like episodes not due to abnormal electrical brain signaling.
   • Possible symptoms: eye closure, head movement, pelvic thrusting, hyperventilation, full-body shaking.

2. Functional Movement Disorder:

   • Affects body movements; includes tremors, myoclonus, dystonia, gait problems, muscle spasms, tics, weakness.

Prevalence and Risk Factors

• Can affect anyone; more common in women.
• Symptoms typically begin in late 20s or 30s.
• Risk factors: psychological stress, childhood adversity, family problems, bullying.
• Often coexists with depression, anxiety, PTSD.

Diagnosis and Treatment

Diagnosing FND

• Based on history, symptoms, and physical exam.
• Use of specific tests like Hoover’s sign, entrainment for tremor.
• May involve EEG, EMG to rule out other disorders.

Treating FND

• Effective communication between healthcare providers and patients is crucial.
• Treatment involves a multidisciplinary approach: physical therapy, psychotherapy, medication.

Psychotherapy:

• Cognitive Behaviour Therapy (CBT), psychodynamic therapy, relaxation, mindfulness exercises.
• Hypnosis for relaxation and symptom reduction.

Medications:

• For pain, anxiety, depression, insomnia, headaches.
• Avoid anti-seizure medications for functional seizures.

Other Treatments:

• Transcranial magnetic stimulation (TMS) and Transcutaneous electrical stimulation (TENS).
• Techniques to avoid harm during episodes.

Research and Clinical Trials

• NINDS and NIH are researching FND's neurobiology and pathophysiology using MRI.
• Aim to develop neuroimaging biomarkers for diagnosis and treatment.
• Participation in clinical trials can help improve understanding and treatment.

Resources for More Information:

• FND Hope International
• Functional Neurological Disorders Society

Related Topics

• Epilepsy and Seizures
• Myoclonus
• Tremor