FND - Functional Neurological Disorder
A functional disorder means that there is an inability or failure of the brain to send and receive signals properly. Click here for information on the website of NIH.
There may be motor, sensory and/or cognitive symptoms that are inconsistent with other conditions.
In 2018, the World Health Organization, WHO, accepted a new description of diseases. There have been changes that mean that (temporary) complaints of pain and (temporary) motor disorders are now recognized as a symptom of FND, provided they cannot be explained by another clinical picture.
The International Classification of Diseases (ICD 11) succeeded the previous WHO classification. FND is recognized as a neurological disease.
With FND there is no damage to the brain, but the nervous system does not function as it should.
There are several misunderstood conditions within neurology that have significant consequences for people, but for which science does not yet have an answer as to the cause. Where in the brain does something go wrong? Is it the ''software'' or the ''hardware''? Are the complaints caused by emotions? Are there other factors?
Everything in the brain is so closely connected that it can take a long time before all questions are answered. There is still a lot to research in the medical world.
People with FND are as likely to report physical limitations, emotional problems and reduced health-related quality of life as people with other neurological conditions.
Scans are inconclusive except in some situations a functional MRI (fMRI). The table of structural MRI studies in functional neurological disorders showed, among other things, reduced pituitary volumes. (Atmaca et al., 2016; Yildirim et al., 2012)
Symptoms
The symptoms can be very diverse and usually there is a combination of symptoms such as:
- walking disorders
- weakness in limbs
- epilepsy-like seizures, psychogenic nonepileptic seizures (PNEA), seizures, blackouts
- tremors (tremors and jerking movements)
- paralysis
- numbness in the skin, sensations in the feeling
- altered sensation in the arm, leg or face on one side of the body (hemisensory syndrome)
- facial spasms
- headache
- hearing less well
- Intermittent vision loss, blurring, blurred vision, double vision
- fatigue
- sleep problems
- cognitive problems
- chronic pain, to a greater or lesser extent
Causes
People with FND often mention triggering circumstances such as an accident, flu, illness, illness that required staying in bed for some time, migraine or migraine-like headache attack, anesthesia, intense emotions, after dissociation or panic attacks.
Provoking causes cannot always be found.
Multidisciplinary treatment options by, among others, well-trained physiotherapists, pain therapists and/or psychologists can sometimes reduce some of the complaints.
More information:
A video about FND:
a PDF for download:
Resources
https://www.neurosymptoms.org/
https://med.stanford.edu/psychiatry/patient_care/fnd.html
https://neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.16110302
https://www.ncbi.nlm.nih.gov/pubmed/17478592
https://onlinelibrary.wiley.com/doi/abs/10.1002/mds.21687
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484222/
Anderson KE, Gruber-Baldini AL, Vaughan CG, et al.: Impact of psychogenic movement disorders versus Parkinson’s on disability, quality of life, and psychopathology. Mov Disord 2007; 22:2204–2209 Crossref,Medline, Google Scholar
Atmaca M., Baykara S., Mermi O., Yildirim H., Akaslan U. Pituitary volumes are changed in patients with conversion disorder. Brain Imaging Behav. 2016;10:92–95. [Google Scholar]
Atmaca M., Aydin A., Tezcan E., Poyraz A.K., Kara B. Volumetric investigation of brain regions in patients with conversion disorder. Prog. Neuro-Psychopharmacol. Biol. Psychiatry. 2006;30:708–713. [PubMed][Google Scholar]
Carson A.J., Brown R., David A.S., Duncan R., Edwards M.J., Goldstein L.H., Grunewald R., Howlett S., Kanaan R., Mellers J., Nicholson T.R., Reuber M., Schrag A.E., Stone J., Voon V., Uk F.N.S. Functional(conversion) neurological symptoms: research since the millennium. J. Neurol. Neurosurg. Psychiatry. 2012;83:842–850. [Google Scholar]
Carson A., Lehn A., Ludwig L., Stone J. Explaining functional disorders in the neurology clinic: a photo story. Pract. Neurol. 2016;16:56–61. [Google Scholar]
LaFrance WC Jr, Deluca M, Machan JT, et al.: Traumatic brain injury and psychogenic nonepileptic seizures yield worse outcomes. Epilepsia 2013; 54:718–725Crossref, Medline, Google Scholar
Carson A, Stone J, Hibberd C, et al.: Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease.’ J Neurol Neurosurg Psychiatry 2011; 82:810–813 Crossref,Medline, Google Scholar
Daum C, Hubschmid M, Aybek S: The value of ‘positive’ clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry 2014;85:180–190Crossref, Medline, Google Scholar
Reuber M, Howlett S, Khan A, et al.: Non-epileptic seizures and other functional neurological symptoms: predisposing, precipitating, and perpetuating factors. Psychosomatics 2007; 48:230–238 Crossref,Medline, Google Scholar
Trimble M., Reynolds E. Handbook of Clinical Neurology. Elsevier; 2016. E
A brief history of hysteria: from the ancient to the modern;; pp. 3-10. [ PubMed ] [ Google Scholar ]
Stone J, Carson A, Duncan R, et al.: Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain 2009; 132:2878–2888Crossref,Medline, Google Scholar
Stone. J,, FRCP, Mark Hallett, MD, Alan Carson, FRCPsych, Donna Bergen, MD, and Raad Shakir, FRCP, Functional disorders in the Neurology section of ICD-11 A landmark opportunity. Neurology. 2014 Dec 9; 83(24): 2299–2301. doi: 10.1212/WNL.0000000000001063