What is it?
The study of Functional Neurological Disorder (FND) goes back decades though the term isnāt familiar to most people. Any progression of our understanding of FND has in the past been hampered by the symptoms being called psychosomatic, and with patients being labelled as āhystericalā or simply āmaking it upā. In the last few years some serious research has been invested into FND and it is now well recognised that the disorder arises when the brain misinterprets normal signals from the body as abnormal. It has been described as āa problem with the functioning of the nervous system in a structurally normal brain or, in the words of Consultant Neurologist and recognised expert in the study of FND, Prof. Jon Stone, it can be viewed as a software problem rather than a hardware problem.
An excellent review by Selma Aybek and David L Perez was publishes by the BMJ in January 20221. Reach welcomes this new approach and the guidance being provided to practioners on how FND can be diagnosed and treated.
You may not have heard of it but FND is a relatively common diagnosis, it is estimated that around 16% of neuro-outpatients receive this diagnosis which is about the same as Multiple Sclerosis. The most common symptoms reported by patients are weakness/movement disorders in the limbs or seizures however, they may also include a number of other key symptoms including; numbness or pain in the face or torso; visual problems, such as double-vision; cognitive problems, such as mental fatigue, forgetfulness and loss of attention. These symptoms look as if they are caused by neurological disease or damage, but they cannot be explained by it. To the patient, these symptoms can be extremely debilitating and limit their ability to have a normal life, but it can be very confusing that a specific diagnosis cannot be given.
FND has an International Classification of Disease Number Eleven (ICD-11) and it is listed in both neurological and psychiatric categories, which is very unusual. It is classified as ādissociative neurological symptom disorderā and regarded as a biopsychosocial disease, which indicates that it has roots in both neurological and social factors while manifesting in physical symptoms. The implication being that it may require a multi-disciplinary team for both diagnosis and treatment.
The sceptics amongst you are probably muttering that it sounds like mumbo-jumbo or a convenient way of fobbing off the worried well off. Not at all, you have probably suffered from a temporary form of FND yourself. Have you ever:
- Had butterflies in your stomach before an exam
- Blushed with embarrassment
- Fainted at the site of blood
- Developed a rash when stressed
If so, you have had a temporary biopsychosocial condition but sadly, other people suffer long term and disabling symptoms.
Diagnosis of Functional Neurological Disorder
Anyone can develop FND but it is most common among young and middle-aged adults, and there are three questions which can illuminate why an individual may have developed it.
- What made them vulnerable? (Were there existing illnesses or stressors?)
- What might have triggered it? (Was there a new illness or a trauma?)
- What keeps the FND going? (Pain, depression, stress or uncertainty surrounding the diagnosis?)
If there are real symptoms in the absence of disease, how can it be diagnosed? Practitioners are now recommended to identify it by the presence of positive diagnostic indicators as opposed to using tests to rule everything else out and then calling it FND.
The article by Aybek and Perez pulls together comprehensive tables of symptoms which reflect positive signs of FND and how these can be tested or confirmed. The increased profile of a positive inclusion diagnosis is illustrated by the establishment, in 2019, of a Functional Neurological Society that is open to all allied healthcare professionals.
Treatment for Functional Neurological Disorder
There is a commonly accepted treatment pattern which shares therapeutic techniques used by Reach neuro-occupational therapy practitioners for the treatment of head and brain injuries and that we have successfully used in the rehabilitation of those with FND.
- Thorough assessment
- Clearly explained diagnosis
- Setting realistic goals with the patient
- Educating and empowering the patient through teaching self-management
- Graded treatment/activity
- Regular communication regarding progress
- Regular MDT meetings and/or liaison with other professionals involved to ensure all are consistently using the same approach
In Reachās experience with brain injured clients, communication of, and education about the diagnosis are crucial elements within a successful rehabilitation programme. After a period of feeling āwhat is wrong with me and will I ever get betterā it is often a huge boost to a patient diagnosed with FND and their families to have information that confirms their diagnosis is of a common disorder. The positive news that there will be a clear plan for rehabilitation provides hope of recovery, where before there was only confusion and despair. This knowledge results in increased positivity about what a rehabilitation programme can achieve, hence an increased commitment to it.
Working with a multi-disciplinary team is extremely advantageous due to the three-pronged nature of the diagnosis but the disciplines involved will depend on the nature of the symptoms.
- A neuropsychologist looking at mood, anxiety and triggers.
- A neurophysiotherapist help with motor retraining and reinforcing normal movement.
- A neuro occupational therapist working on engagement with all aspects of normal life reinforcing normal movement during everyday activities. The use of adaptive equipment should be avoided as it reinforces the presence of the symptoms.
- A neuropsychiatrist addresses all of the mental health aspects.
- Other disciplines, such as a neuro speech and language therapists may also be appropriate, dependent on the presentation of symptoms.
About Reach Personal Injury
Reachās specialist Neuro-Occupational Therapists are very experienced in working with patients undertaking this type of treatment and Reachās rehabilitation programmes have been benefitting patients with diagnosis of FND and other neurological disorders for almost 30 years.
At Reach we are firmly committed to creating rehabilitation programmes which are patient centred and believe that education is a key factor in their success. We are continually innovating our approach based on the most up to date research. For example the use of apps, such as MyFND are employed to empower patients to take a leading role in their rehabilitation.
If you are interested in knowing more about Reachās work with FND and head trauma patients please refer to our profile and contact a member of our team.
How can Brain Injury Group help?
Brain Injury Group is a network of approved personal injury solicitors with brain injury expertise. Moreover, our member firms have the complex injury experience to get the best possible rehabilitation and compensation for brain injuries.
Brain injury rehabilitation is important; to us, to our members, to you and towards getting the best outcome. We can help get you that best outcome. Get in touch to find out more from our brain injury experts.
Contact us – to get in touch you can either:
- Call us on 0800 612 9660 or 03303 112541
- Email us at enquiries@braininjurygroup.co.uk
- Complete this short enquiry form and we’ll get back to you
- Find a specialist brain injury solicitor near to you
Reference
1 Aybek S, Perez D L. Diagnosis and management of functional neurological disorder BMJ (2022) [Online] https://doi.org/10.1136/bmj.o64, (Accessed 18 July 2022)
