Functional Neurological Disorder (FND) is a relatively new term used to describe neurological symptoms such as limp weakness, tremor, numbness and blackouts. The condition is caused by a problem with the functioning of the nervous system. It is a software issue of the brain and not a hardware issue as in a stroke or MS.
There are many potential reasons why an individual can become vulnerable to FND and there can be predisposing factors, triggering factors and perpetuating factors. Triggering events can include injury, panic attack, migraine, neurological illness, drug side effect and minor head injury. Predisposing factors can include Functional Disorders (e.g. pain syndrome, irritable bowel syndrome), neurological conditions (e.g. migraine), anxiety/depressions, stressful life events or childhood adversity. Perpetuating factors can include feeling disbelieved, misdiagnosis, opiate medication, unnecessary surgery and even on-going legal cases.
FND can be described as old wine in new bottles. Neurologists refer to it as Functional Neurological Disorder (Conversion Disorder) and Psychiatrists call it Conversion Disorder. Over the years this condition has had many labels and in the past this has been called hysterical paralysis. As soon as an authentic physical symptom is considered of psychological origin, it takes on pejorative connotations and so the language with which Neurologists and Psychiatrists describe these symptoms tends to change every decade. Fairly consistently, a quarter of neurology outpatients have presented with FND and up to half of inpatients. However, a study by Michael Sharpe at Oxford University showed that neurology textbooks a decade ago had far more information on FND than now. So, although the new classification helps to overcome some of the false mind-body dualism that used to exist, in some respects some help and services have deteriorated as some Neurologists can still be fairly dismissive. Notable exceptions are the Neurology services in Edinburgh and St George’s in London which are centres of excellence and where there are specialist departments that treat patients with the condition.
Treatment of the condition can be difficult as patients often find it hard to understand that there are often no physical causes for their symptoms and gaining this understanding before treatment commences is key to the success of their treatment. However, waiting lists for treatment are over 12 months and it is not readily available for everyone. In the past, the condition has been treated using hypnotherapy but this form of treatment is rarely used now. Treatments such as talking therapy, Cognitive Behavioural Therapy and Occupational Therapy can be helpful but only if the patient accepts that it is a psychiatric condition. Some patients have been offered inpatient treatment at the centres of excellence which can involve a two to three-month inpatient treatment programme with a multidisciplinary approach (with psychology, neurology, physiotherapy and occupational therapy) and 60% of the patients who receive inpatient treatment improve substantially. Essentially, the more a patient understands the condition the more responsive to treatment they will be.
The more severe cases of FND can include paralysis, inability to walk, problems with swallowing and an inability to see or speak. The milder symptoms can include a tremor. There tends to be more women than men who suffer from the condition which can often be explained by the fact that men don’t tend to ask for help. However, conditions such as Gulf War Syndrome are likely to be a manifestation of the same condition.
Produced by Elizabeth Whitehead, Senior Associate Team Leader at Irwin Mitchell Solicitors
Elizabeth (Liz) Whitehead is a Senior Associate Team Leader in the serious injury department in Irwin Mitchell’s Sheffield office. Liz specialises in road traffic collisions and accidents at work including fatal accidents.
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