Functional Neurological Disorder (FND) is a disruption in the functioning of the nervous system, affecting the transmission of signals between the brain and body. It is considered a condition that lies directly at the intersection of neurology and psychiatry that historically has failed to gain the interest of researchers and clinicians.

 

Triggered by physical or psychological trauma, FND manifests in diverse symptoms, including physical, sensory, and cognitive impairments, profoundly impacting quality of life.In FND, the normal pathways your brain uses to move, feel, speak, walk, and/or think, are disrupted. This promotes symptoms such as paralysis (not being able to move part of the body), functional seizures, extra movements such as tremor or jerks, problems with memory, etc.These are real neurological symptoms, yet they can not be explained by an organic disease. 

 

​

Distinguishing Between Organic and Functional Disease

An organic disease is one in which there is a measurable change to tissues, organs, or body systems. The cause and disease pathway have largely been established as the diagnosis can be confirmed with specific tests like blood work and imaging.

​

A functional disease is one in which there are abnormal symptoms or changes in function but with no measurable changes in tissues. The cause and disease pathway are often less understood as there are no available tests to confirm. It is typical for patients to go through endless tests and imaging that typically turn up negative. A diagnosis is based largely on diagnostic criteria. This lack of understanding leads to a great deal of frustration for patients as it can take years to even receive a proper diagnosis.

​

​

Software vs. Hardware Analogy

The hardware vs. software analogy can be used to explain FND. Imagine that your brain is a computer which contains hardware (the physical components) and software (the operating system) The hardware and software communicate and work together to help function. With FND, it’s like one of the programs with the software isn’t working properly (for example, the program for how to walk) or in some cases like the computer is crashing (like with functional seizures). The hardware, or structure of the brain, is normal (an example of a hardware problem of the brain would be something like a stroke or MS). This software issue causes the brain/body to glitch, malfunction and shutdown, just as a computer might with a software problem.

 

 

FND Symptoms

For some, symptoms can be permanent, while for others, symptoms come and go in waves referred to as flare ups or episodes. Symptoms may often mimic a wide range of other neurological conditions such as MS or Parkinson’s disease.

 

Symptoms include, but are not limited to:

Gait and balance problems

Involuntary movements

Cognitive changes

Paralysis and weakness

Functional seizures

Sensory changes

Chronic pain

Bladder and bowel changes

Speech problems

Visual changes

Headaches and migraines

Sleep disturbances

Swallowing difficulties

 

FND Treatment

Treatment for FND will depend on particular symptoms.

​

​

Therapies

Physical, occupational, and/or speech therapy

Cognitive behavioural therapy (CBT) or psychotherapy

 

​

Medication

“Sedative medications in general quite often reduce symptoms from FND (e.g. benzodiazepines, baclofen, opiates), but the downside of these drugs are often very significant. This is particularly the case for pain, a very common accompaniment to FND. Many FND patients are on huge quantities of sedative medications like oral morphine, tramadol, codeine. These drugs do usually dull the pain to some extent, but they rarely reduce it significantly and in the long term the doses of the drugs have to escalate to get the same effect.” (fndhope.org)