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  • Functional neurological symptom disorder

    Functional neurological symptom disorder


    • Functional neurological symptom disorder (FNsD) is a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts. The brain of a patient with functional neurological symptom disorder is structurally normal, but functions incorrectly. In broad terms, there is a problem with the patient's central nervous system, which is not sending and receiving signals correctly. Other terms for functional neurological symptom disorder represent changing ideas and attitudes to these disorders and include functional neurological disorder (FND), conversion disorder, and psychogenic movement disorder/non-epileptic seizures. The cause of functional neurological disorders is considered to be multifactorial, which means many different factors can contribute to the development of the disorder. With greater understanding of the brain most diseases including functional neurological disorders should be thought of as having biological, psychological and social components (the biopsychosocial disease model). Functional neurological disorders are common in neurological services, accounting for up to one third of outpatient neurology clinic attendances, and associated with as much physical disability and distress as other neurological disorders. The diagnosis is made based on positive signs and symptoms in the history and examination during consultation of a neurologist (see below). Assessment demonstrates that normal function of the nervous system is possible. The best evidence for treatment for functional neurological disorders from recent studies suggest that physiotherapy and/or psychological therapy can both be helpful depending on the individual patient. Physiotherapy is particularly helpful for patients with motor symptoms (weakness, gait disorders, movement disorders) and tailored cognitive behavioural therapy has the best evidence in patients with dissociative (non-epileptic) attacks.

      Although the DSM-5 uses the term "functional neurological symptom disorder", many other names for the same condition are widely used by doctors. These include:

      There are a great number of symptoms experienced by those with functional neurological disorder. It is important to note that all the symptoms which are experienced by those with FNsD are real, and often debilitating. The core symptoms are those of motor or sensory function or episodes of altered awareness



      • Limb weakness or paralysis
      • Blackouts (also called dissociative or non-epileptic seizures/attacks) – these may look like epileptic seizures or faints
      • Movement disorders including tremors, dystonia (spasms), myoclonus (jerky movements)
      • Visual symptoms including loss of vision or double vision
      • Speech symptoms including dysphonia (whispering speech), slurred or stuttering speech
      • Sensory disturbance including hemisensory syndrome (altered sensation down one side of the body)
      • With weakness or paralysis
      • With abnormal movement (e.g., tremor, dystonic movement, myoclonus, gait disorder)
      • With swallowing symptoms
      • With speech symptoms (e.g., dysphonia, slurred speech)
      • With attacks or seizures
      • With anaesthesia or memory loss
      • With special sensory symptom (e.g., visual, olfactory,or hearing disturbance)
      • With mixed symptoms.
      • Acute episode: symptoms present for less than 6 months
      • Persistent: symptoms present for 6 months or more.
      • Physiotherapy and occupational therapy
      • Psychological therapy including cognitive behavioural therapy and other forms of psychotherapy directed specifically at FND symptoms or at other functional or psychological symptoms if present
      • Medication such as sleeping tablets, painkillers, anti-epileptic medications and anti-depressants
      • 2009 Neurosymptoms.org is written by Dr Jon Stone a neurologist who specialises in FND.
      • 2012 FND Hope is an international registered charity in the United States.
      • 2016 FND/CD is written by a patient.
      • 2016 FND Action is a charity registered in England and Wales.
      • Patients are imagining their symptoms
        • The symptoms are not just 'imagined', they are real. FND exists at the interface between neurology and psychiatry and cannot be easily categorised in to either speciality completely.
      • Patients are pretending to have symptoms
        • If a patient is pretending to have symptoms, this is called 'feigning', 'malingering', 'factitious disorder' or 'Munchausen syndrome'. An fMRI study has shown that the brain activity in someone simulating weakness is different to that of someone with a functional weakness. The belief that patients with FND are feigning is demoralizing to suffering patients and can become a major roadblock in a patient's ability to access treatment and care.
      • Functional neurological disorder is caused by psychological dysfunction or an emotional problem
        • Psychological factors may be important in many patients but not all, and psychological factors cannot be used to make a diagnosis.
        • No biomarkers have been found to support this theory
      • Functional neurological symptom disorder only affects females
        • "The ratio of females to males ranges from 2:1 up to 10:1"
      • Functional neurological symptom disorder only affects young adults
      • Functional neurological symptom disorder is rare
        • FNsD affects between 0.011% and 0.5% of the general population
      • The symptoms are not just 'imagined', they are real. FND exists at the interface between neurology and psychiatry and cannot be easily categorised in to either speciality completely.
      • If a patient is pretending to have symptoms, this is called 'feigning', 'malingering', 'factitious disorder' or 'Munchausen syndrome'. An fMRI study has shown that the brain activity in someone simulating weakness is different to that of someone with a functional weakness. The belief that patients with FND are feigning is demoralizing to suffering patients and can become a major roadblock in a patient's ability to access treatment and care.
      • Psychological factors may be important in many patients but not all, and psychological factors cannot be used to make a diagnosis.
      • No biomarkers have been found to support this theory
      • "The ratio of females to males ranges from 2:1 up to 10:1"
      • FNsD affects between 0.011% and 0.5% of the general population
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