Functional Neurological Disorders (FNDs) are a group of conditions that involve genuine neurological symptoms such as paralysis, movement difficulties, sensory problems, and unexplained seizures. These symptoms are the result of abnormal functioning in the nervous system rather than structural damage or disease. The symptoms may mirror or coexist with other conditions such as migraine, multiple sclerosis (MS), and epilepsy, though FNDs typically do not result in physical disability.

Understanding FNDs: A Simple Analogy

To better understand FNDs, think of a computer. When a computer malfunctions, it’s often due to issues with its “software” (programming and coding), rather than its “hardware” (keyboard, screen, or hard drive). Similarly, in FNDs, while the “hardware” of your body (such as the brain and nerves) isn’t damaged, the “software” (how the brain processes and sends signals to the body) doesn’t function properly, leading to symptoms that can feel as though the body is malfunctioning.

Causes of FNDs

The causes of Functional Neurological Disorders remain largely unknown, though research continues to explore this area. FNDs rarely have a single cause and can vary significantly from person to person. Some potential triggers or factors that can exacerbate or prolong symptoms include:

• Physical injury: A past injury may be a trigger.
• Illness and prolonged fatigue: Conditions that require extended bed rest can sometimes lead to FNDs.
• Emotional events or trauma: Stressful life events, trauma, or complicated grief can trigger symptoms.
• Current stressors: Ongoing pressures, such as work or family stress, can exacerbate symptoms.
• Family history of neurological conditions: A genetic predisposition may play a role.
• Heightened attention to symptoms: Worrying about or focusing on bodily symptoms can sometimes worsen the condition.
• High levels of anxiety: Anxiety and stress are common contributing factors.

In some cases, the circumstances leading to FNDs can accumulate over time. Many individuals find it challenging to pinpoint a single cause for their symptoms, leading to confusion, frustration, and anxiety.

Symptoms of FNDs

The symptoms of Functional Neurological Disorders vary widely between individuals but can include:

• Chronic pain
• Fatigue and tiredness
• Poor concentration and memory
• Gait and balance problems
• Headaches and migraines
• Involuntary movements (such as shakes, tremors, or jerks)
• Paralysis and weakness
• Non-epileptic seizures
• Sensory changes
• Sleep disturbances
• Speech problems
• Bladder and bowel changes
• Visual impairments
• Difficulty completing daily activities

It’s essential to note that these symptoms are real, not imagined. Individuals with FNDs have no conscious control over these symptoms, which can fluctuate or change over time.

Diagnosis of FNDs

A diagnosis of Functional Neurological Disorder is typically made following a physical examination and a series of investigations aimed at ruling out other physical causes. Diagnosis is often performed by neurologists or psychiatrists who will work to exclude other conditions and evaluate the patterns of symptoms.

Treatment for FNDs

Treatment for FNDs varies depending on the severity of symptoms and the individual’s unique situation. It is usually a multidisciplinary approach that may include:

• Psychotherapy: Techniques such as Cognitive Behavioural Therapy (CBT) can help individuals understand the psychological factors that may be contributing to their symptoms.
• Physiotherapy: A physiotherapist can assist with mobility and physical rehabilitation to improve strength and coordination.
• Antidepressants: In some cases, medications, particularly antidepressants, may be used to manage symptoms related to anxiety or depression that often co-occur with FNDs.

The combination of treatments is tailored to each person’s needs and may require ongoing support.