Functional Disorders Flashcards
What are functional neurological disorders?
Functional Neurological Disorders (FND’s) is the name given for symptoms in the body which appear to be caused by problems in the nervous system but which are not caused by a physical neurological disease or disorder.
Health professionals sometimes call these disorders ‘medically unexplained’, psychosomatic or somatisation. We prefer the term ‘functional’ which just means that the body is not functioning quite as it should.
How common are functional neurological disorders?
FNDs are quite common, occurring in about one quarter of the patients we see in our neurology clinics.
For most people these symptoms are short-lived, but for others they persist for months or years and are very disabling. Symptoms tend to change with time, and as a result patients may often repeatedly consult their doctors for advice or investigation.
Many doctors also find these conditions puzzling, and patients may find that they become frustrated by the shortage of information about why these symptoms occur and what to do about them.
What are the common symptoms of functional neurological disorders?
- Sensory → negative (loss of sensation) or positive (sensory overload, tingling, crawling, pain)
- Difficulty concentrating
- Memory problems
- Variable fatigue
- Movement → slowed down, can’t control limbs, twitches, tremors
- Functional seizures
When symptoms become more chronic they can cause a lot of problems, with a third of affected patients not being able to work. Patients are often very distressed by their symptoms.
How are FNDs diagnosed?
- Investigations to rule out alternative causes / neurological disease
- Indicates symptoms are functional
- Thorough clinical assessment - symptom nature, fluctuation, how they evolve
- Diagnosis can take many years
Functional seizures are a type of functional neurological symptom. Many different words are used for functional seizures. The more commonly used terms include non-epileptic seizures, non-epileptic attack disorder (NEAD) non-epileptic events, dissociative seizures, pseudo seizures, pseudo-epileptic seizures, psychogenic seizures, or conversion seizures.
What are the symptoms of functional seizures?
Functional seizures often look like epileptic attacks or fainting spells but there are often clues in the description such as:
- very frequent, prolonged attacks
- those in which body movements come + go
- attacks where person is emotionally upset afterwards
Like epileptic seizures, functional seizures can cause blacking out, collapsing, injuries and loss of bladder control. Functional seizures are not consciously produced to achieve something.
What is the treatment for functional neurological disorders?
- specialist CBT
- transcranial magnetic stimulation (motor FND)
- neurophysiotherapy
The treatment approach is multidisciplinary and professionals include: physiotherapist, OTs, neuropsychologists, SALT, specialist nursing and neuropsychiatry. Also regular input from rehabilitation, urology and neurology consultants.
This holistic approach seeks to treat every patient using the bio-psycho-social model.
