Functional Neurological Disorder (FND), is a condition characterised by neurological symptoms that cannot be explained by an underlying organic or structural neurological disease. In FND, there is a mismatch between the physical symptoms and the known anatomy or physiology of the nervous system. The symptoms are believed to be related to how the brain functions rather than structural abnormalities.
FND is caused by a complex combination of biological, psychological and social factors on the brain, however the exact cause of FND remains unknown. Ongoing research is beginning to provide suggestions. There are many different factors that can make patients more susceptible to FND including having another neurological condition, experiencing chronic pain, fatigue or stress, but some patients do not possess these risk factors.
There is no definitive procedure to diagnose FND. Diagnosing FND can be challenging, and it often involves a comprehensive evaluation by healthcare professionals. Diagnosis is typically made based on clinical features, exclusion of other neurological disorders, and sometimes the presence of specific psychological factors. Diagnosis should be followed by an explanation and discussion of diagnosis.
Patients with FND may experience a wide range of symptoms that are physical, sensory and/or cognitive. The most common include:
functional limb weakness/paralysis
functional movement disorders e.g.tremor, dystonia
functional speech symptoms e.g. dysphonia, dysarthria or stutter
functional sensory disturbance including altered sensation (often on one side of the body)
functional visual symptoms e.g. double vision
Episodes of altered awareness:
dissociative seizures, blackouts and faint (these may overlap).
Symptoms may often fluctuate, vary or be present all the time. Patients may experience remissions, as well as relapse of symptoms. Psychological factors often (but not always) play a role in FND. Stress, trauma, or emotional distress may be associated with the onset or exacerbation of symptoms. However, it’s important to note that FND is not consciously produced and is not considered malingering.
How Can We Help?
Physiotherapy & Exercise Physiology
Physiotherapists and Exercise Physiologists will look at your movement, strength, coordination and balance. They may also review any pain or fatigue you may be experiencing. They will then discuss goals important to you and assist you to develop a plan to achieve those goals using evidence based treatment strategies. Your treatment program may contain a range of exercises or strategies to help you to improve mobility, balance, and daily function. Physiotherapists may also make recommendations regarding mobility equipment and advise you on safe ways to keep moving and prevent falls.
Occupational Therapists are important in managing your symptoms and improving your daily life.
Occupational Therapists will assess how well you are managing day-to-day tasks, such as, eating, dressing, cooking, or bed mobility. This means that their assessments are typically completed in the home environment. Occupational Therapists can teach strategies and recommend equipment to make your home safer and more manageable.
Speech Pathologists will assess all aspects of communication including speech, language and voice quality. They will assess the impact of your symptoms on your daily life, and work with you to develop a management plan. Therapy may be beneficial in helping you to improve your quality of life and reach your goals. They can also assist in the use of a communication device when necessary.
Speech Pathologists also assess and treat swallowing difficulties to help you enjoy your mealtimes safely.