What are functional neurological disorders?
Functional neurological disorder (or FND) is a disorder in which the brain and body do not function harmoniously. The problem lies within the central nervous system. The normal pathways the brain uses to send and receive signals to move, feel, speak or think become disrupted leading to a range of motor and/or sensory symptoms.
How common is FND?
- FND is a common neurological disorder, with 4–12 per 100,000 people affected each year (worldwide).
- 1 in 3 patients presenting to hospitals are diagnosed with FND.
- FND can occur across the age spectrum but is more common in adults. Females are 3 times more likely to be diagnosed with FND than males. But, as age increases more males are diagnosed with FND.
What are the symptoms?
For many people with FND, their symptoms can be severe, disabling and life-changing. If you have FND, the symptoms you experience are real and affect your ability to complete daily tasks. Your symptoms may appear unexpectedly and look very different to someone else’s.
Paying attention to symptoms increases their occurrence, while distraction decreases them. Keep in mind the symptoms you experience may occur at the same time as other neurological disorders.
Symptoms can include (but are not limited to):
- limb weakness
- shaking
- disturbed cognitive function (e.g., memory and thinking)
- speech disturbances
- difficulty swallowing
- dissociative attacks
- changes in the ability to walk and stand
- balance problems
- dizziness
- visual disturbances
- chronic pain
- fatigue
- anxiety
- depression.
What are the risk factors?
No single process or factor has been identified to explain the onset of FND. It is a complex combination of biological, psychological and social factors on the brain:
- Biological factors include genetics, early childhood trauma and physical injury or illness.
- Psychological factors include emotional or personality disorders and perception of life and illness.
- Social factors include childhood trauma, family dynamics, uncertainty, anxiety, maltreatment and stress.
How is it diagnosed?
FND is usually diagnosed by a neurologist. Your neurologist will take a detailed medical history and perform a thorough physical examination. A diagnosis of FND is made based on well-recognised clinical signs.[1]
Your neurologist may also order others tests and possibly scans. These will help check your general health and identify any other health problems.
What can I do?
It is useful to make a list or diary of your symptoms, the medications you are taking and your family history. Also, include any questions you may have for your doctor. Be ready to discuss your past experiences, mental health concerns and major life changes.
It is important to maintain a healthy lifestyle. This includes regular exercise, a balanced diet and adequate sleep. Additionally, mindfulness, art therapies and hobbies can provide useful distractions and reduce stress and anxiety.
What does my treatment involve?
It is often helpful to think of your brain as a computer. In someone with FND, there is no damage to the hardware or structure of the brain. It is the software or program running on the computer that isn’t working properly. There may be too many apps open—or too much going on at once. This can slow down your computer or even freeze it. Treatment can help you to minimise or close all the open apps and correct any software malfunctions.
Treatment can be successful. It should start as soon as possible and generally uses a multidisciplinary approach that is tailored to you. Your team may include one or more professionals depending on the symptoms you are experiencing:
- GP: your GP is often the first point of contact regarding your health and will examine you to rule out other disorders. Your GP will usually refer you to a neurologist and follow up treatment with them.
- neurologist: will make a diagnosis of FND based on your history, neurological examination and positive signs, then explain your diagnosis and recommend treatment
- physiotherapist: provides education and self-management strategies and assists your movements
- occupational therapist: helps you understand how your activities fit into your daily life
- speech therapist: helps you with speech, swallowing and self-management strategies
- nurse: checks you at the hospital and plan daily activities aligned with your treatment. Nurses provide emotional and educational support to you and your family and can help you navigate the healthcare system.
- psychiatrist: a medical doctor that may prescribe and regulate medication for you
- psychologist: helps you to better understand FND and teach coping strategies such as cognitive behavioural therapy (CBT). This therapy helps you to identify and alter any patterns of behaviours, cognition and emotions that might contribute to your symptoms.
Treatment may also include medication. This helps with pain, anxiety, depression, insomnia or headaches.
What can I expect the outcome to look like?
The earlier the diagnosis occurs, the sooner treatment can begin and the better chance you have of preventing the symptoms from occurring or worsening.
Receiving clear communication and education from your healthcare providers can assist in building confidence and hope for a positive outcome. It is important that people diagnosed with FND take the time to learn how to manage their symptoms. They should work towards balancing their activities so they can start enjoying life again.
Where can I find more information about FND?
- FND Hope: https://fndhope.org/
- FND Guide: www.neurosymptoms.org
- FND Australia: www.fndaustalia.com.au
A self-guided workbook is available to help you understand and self-manage FND and track your progress. The workbook is available from FND Australia: https://fndaustralia.com.au/resources/FND_Workbook_FNDAustralia_June_2020.pdf
Where can I get help for FND?
If you or someone you care about has FND, you are not alone, and help is available.
The Neurological Council’s team of community neurological nurses know the challenges of FND. They can help people living with FND through education, support and the coordination of referrals to key health practitioners.
For more information, please visit: https://www.ncwa.com.au/
Our friendly team can be contacted Monday to Friday, from 8.30 am to 4.30 pm.
- Phone: 1800 645 771 (free call) or 6457 7533.
- Email: hello@ncwa.com.au
Self-referrals are welcome using our online referral form: https://www.ncwa.com.au/help-for-you/referrals
References:
[1] See FND Australia’s FND online course for patients for a short video explaining how FND is diagnosed: https://fndaustralia.com.au/resources/resources/online-learning.html