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Functional neurologic disorder

April 14, 2024

Functional neurologic disorder or functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms, and blackouts. As a functional disorder, there is by definition no known disease process affecting the structure of the body, yet the person experiences symptoms relating to their body function. Symptoms of functional neurological disorders are clinically recognisable, but are not categorically associated with a definable organic disease.[1][2]

The intended contrast is with an organic brain syndrome, where a pathology (disease process) can be identified which affects the body's physiology. Subsets of functional neurological disorders include functional neurological symptom disorder (FNsD), conversion disorder, functional movement disorder, and functional seizures. The diagnosis is made based on positive signs and symptoms in the history and examination during consultation of a neurologist.[3]

Physiotherapy is particularly helpful for patients with motor symptoms (weakness, gait disorders, movement disorders) and tailored cognitive behavioural therapy has the best evidence in patients with dissociative (non-epileptic) attacks.[4][5]

Signs and symptoms edit

There are a great number of symptoms experienced by those with a functional neurological disorder. While these symptoms are very real, their origin is complex, since it can be associated with severe psychological trauma (conversion disorder), and idiopathic neurological dysfunction.[6] The core symptoms are those of motor or sensory dysfunction or episodes of altered awareness:[7][8][9][10]

  • Limb weakness or paralysis
  • Blackouts (also called dissociative or non-epileptic seizures/attacks) – these may look like epileptic seizures or faints
  • Movement disorders including tremors, dystonia (spasms), myoclonus (jerky movements)
  • Visual symptoms including loss of vision or double vision
  • Speech symptoms including dysphonia (whispering speech), slurred or stuttering speech
  • Sensory disturbance including hemisensory syndrome (altered sensation down one side of the body)
  • Dizziness and balance problems

Associated conditions edit

Epidemiological studies and meta-analysis have shown higher rates of depression and anxiety in patients with FND compared to the general population, but rates are similar to patients with other neurological disorders such as epilepsy or Parkinson's disease. This is often the case because of years of misdiagnosis and accusations of malingering.[11][12][13][14]

Causes edit

A systematic review found that stressful life events and childhood neglect were significantly more common in patients with FND than the general population, although some patients report no stressors.[15]

Converging evidence from several studies using different techniques and paradigms has now demonstrated distinctive brain activation patterns associated with functional deficits, unlike those seen in actors simulating similar deficits. [16] The new findings advance current understanding of the mechanisms involved in this disease, and offer the possibility of identifying markers of the condition and patients' prognosis.[17][18]

FND has been reported as a rare occurrence in the period following general anesthesia.[19]

Diagnosis edit

A diagnosis of a functional neurological disorder is dependent on positive features from the history and examination.[20]

Positive features of functional weakness on examination include Hoover's sign, when there is weakness of hip extension which normalises with contralateral hip flexion.[21] Signs of functional tremor include entrainment and distractibility. The patient with tremor should be asked to copy rhythmical movements with one hand or foot. If the tremor of the other hand entrains to the same rhythm, stops, or if the patient has trouble copying a simple movement this may indicate a functional tremor. Functional dystonia usually presents with an inverted ankle posture or clenched fist.[22] Positive features of dissociative or non-epileptic seizures include prolonged motionless unresponsiveness, long duration episodes (>2minutes) and symptoms of dissociation prior to the attack. These signs can be usefully discussed with patients when the diagnosis is being made.[23][24][25][26]

Patients with functional movement disorders and limb weakness may experience symptom onset triggered by an episode of acute pain, a physical injury or physical trauma. They may also experience symptoms when faced with a psychological stressor, but this isn't the case for most patients. Patients with functional neurological disorders are more likely to have a history of another illness such as irritable bowel syndrome, chronic pelvic pain or fibromyalgia but this cannot be used to make a diagnosis.[27]

FND does not show up on blood tests or structural brain imaging such as MRI or CT scanning. However, this is also the case for many other neurological conditions so negative investigations should not be used alone to make the diagnosis. FND can occur alongside other neurological diseases and tests may show non-specific abnormalities which cause confusion for doctors and patients.[27]

ICD-11 diagnostic criteria edit

The International Classification of Disease (ICD-11) have listed functional disorders within the neurology section for the first time,[28] where they are named "Dissociative neurological symptom disorder".[29]

DSM-5 diagnostic criteria edit

The Diagnostic and Statistical Manual of Mental Illness (DSM-5) lists the following diagnostic criteria for functional neurological symptoms (conversion disorder):

  1. One or more symptoms of altered voluntary motor or sensory function.
  2. Clinical findings can provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
  3. Another medical or mental disorder does not better explain the symptom or deficit.
  4. The symptom or deficit results in clinically significant distress or impairment in social, occupational, or other vital areas of functioning or warrants medical evaluation.[30]

Differential diagnoses edit

Multiple sclerosis has some overlapping symptoms with FND, potentially a source of misdiagnosis.[31]

Treatment edit

Treatment requires a firm and transparent diagnosis based on positive features which both health professionals and patients can feel confident about.[18] It is essential that the health professional confirms that this is a common problem which is genuine, not imagined and not a diagnosis of exclusion.[32]

A multi-disciplinary approach to treating functional neurological disorder is recommended. Treatment options can include:[33]

  • Physiotherapy and occupational therapy
  • Medication such as sleeping tablets, painkillers, anti-epileptic medications and anti-depressants (for patients with depression co-morbid or for pain relief)

Physiotherapy with someone who understands functional disorders may be the initial treatment of choice for patients with motor symptoms such as weakness, gait (walking) disorder and movement disorders. Nielsen et al. have reviewed the medical literature on physiotherapy for functional motor disorders up to 2012 and concluded that the available studies, although limited, mainly report positive results.[34]

For many patients with FND, accessing treatment can be difficult. Availability of expertise is limited and they may feel that they are being dismissed or told 'it's all in your head' especially if psychological input is part of the treatment plan. Some medical professionals are uncomfortable explaining and treating patients with functional symptoms. Changes in the diagnostic criteria, increasing evidence, literature about how to make the diagnosis and how to explain it and changes in medical training is slowly changing this.[35]

Prevalence edit

Dissociative (non-epileptic) seizures account for about 1 in 7 referrals to neurologists after an initial seizure, and functional weakness has a similar prevalence to multiple sclerosis.[36]

History edit

From the 18th century, there was a move from the idea of FND being caused by the nervous system. This led to an understanding that it could affect both sexes. Jean Martin Charcot argued that, what would be later called FND, was caused by "a hereditary degeneration of the nervous system, namely a neurological disorder".[37]

In the 18th century, the illness was confirmed as a neurological disorder but a small number of doctors still believed in the previous definition.[37] However, as early as 1874, doctors, including W.B. Carpenter and J.A. Omerod, began to speak out against this other term due to there being no evidence of its existence.[38]

Although the term "conversion disorder" has been used for many years, another term was still being used in the 20th century. However, by this point, it bore little resemblance to the original meaning. It referred instead to symptoms that could not be explained by a recognised organic pathology, and was therefore believed to be the result of stress, anxiety, trauma or depression. The term fell out of favour over time due to the negative connotations. Furthermore, critics pointed out that it can be challenging to find organic pathologies for all symptoms, and so the practice of diagnosing that patients who had such symptoms were imagining them led to the disorder being meaningless, vague and a sham-diagnosis, as it did not refer to any definable disease.[38]

Throughout its history, many patients have been misdiagnosed with conversion disorder when they had organic disorders such as tumours or epilepsy or vascular diseases. This has led to patient deaths, a lack of appropriate care and suffering for the patients. Eliot Slater, after studying the condition in the 1950s, was outspoken against the condition, as there has never been any evidence to prove that it exists. He stated that "The diagnosis of 'hysteria' is a disguise for ignorance and a fertile source of clinical error. It is, in fact, not only a delusion but also a snare".[38]

In 1980, the DSM III added 'conversion disorder' to its list of conditions. The diagnostic criteria for this condition are nearly identical to those used for hysteria. The diagnostic criteria were:[citation needed]

A. The predominant disturbance is a loss of or alteration in physical functioning suggesting a physical disorder. It is involuntary and medically unexplainable

B. One of the following must also be present:

  1. A temporal relationship between symptom onset and some external event of psychological conflict.
  2. The symptom allows the individual to avoid unpleasant activity.
  3. The symptom provides opportunity for support which may not have been otherwise available.

During the COVID-19 pandemic, neurologists noticed an increase in adolescents and young adults presenting with functional tic-like behaviors to clinics around the world.[39] Researchers believe that social media content regarding Tourette Syndrome influenced the sudden increase in functional tic-like behaviors.[40] The majority of the people who experienced functional tic-like behaviors were female, and neurologists have reported an overrepresentation of transgender and non-binary identities within this group of adolescents and young adults.[41]

Today, there is a growing understanding that symptoms are real and distressing, and are caused by an incorrect functioning of the brain rather than being imagined or made up.[42]

Controversy edit

There was historically much controversy surrounding the FND diagnosis. Many doctors continue to believe that all FND patients have unresolved traumatic events (often of a sexual nature) which are being expressed in a physical way. However, some doctors do not believe this to be the case. Wessely and White have argued that FND may merely be an unexplained somatic symptom disorder.[43] FND remains a stigmatized condition in the healthcare setting.[44][45]

References edit

  1. ^ Stone J, Sharpe M, Rothwell PM, Warlow CP (May 2003). "The 12 year prognosis of unilateral functional weakness and sensory disturbance". Journal of Neurology, Neurosurgery, and Psychiatry. 74 (5): 591–596. doi:10.1136/jnnp.74.5.591. PMC 1738446. PMID 12700300.
  2. ^ Aybek S, Perez DL (January 2022). "Diagnosis and management of functional neurological disorder". BMJ. 376: o64. doi:10.1136/bmj.o64. PMID 35074803. S2CID 246210869.
  3. ^ Carey, Katie; Watson, Meagan (2003). Reset & Rewire: The FND Workbook for Kids & Teens. Houston, TX: Illustrated Nurse Press. p. 4. ISBN 9798218232047.
  4. ^ Lehn A, Gelauff J, Hoeritzauer I, Ludwig L, McWhirter L, Williams S, et al. (March 2016). "Functional neurological disorders: mechanisms and treatment". Journal of Neurology. 263 (3): 611–620. doi:10.1007/s00415-015-7893-2. PMID 26410744. S2CID 23921058.
  5. ^ Goldstein LH, Robinson EJ, Chalder T, Reuber M, Medford N, Stone J, et al. (March 2022). "Six-month outcomes of the CODES randomised controlled trial of cognitive behavioural therapy for dissociative seizures: A secondary analysis". Seizure. 96: 128–136. doi:10.1016/j.seizure.2022.01.016. PMC 8970049. PMID 35228117.
  6. ^ "Functional neurologic disorders/conversion disorder - Symptoms and causes". Mayo Clinic. Retrieved 2022-01-04.
  7. ^ "Functional neurological symptom disorder". www.medicalnewstoday.com. 2022-01-05. Retrieved 2022-01-08.
  8. ^ "Functional neurologic disorders/conversion disorder - Symptoms and causes". Mayo Clinic. Retrieved 2022-01-08.
  9. ^ "Functional Neurological Disorder". Physiopedia. Retrieved 2022-01-08.
  10. ^ "Symptoms – Functional Neurological Disorder (FND)". Retrieved 2022-08-18.
  11. ^ Fiszman A, Kanner AM (2010). Schachter SC, LaFrance Jr WC (eds.). Gates and Rowan's nonepileptic seizures (3rd ed.). Cambridge: Cambridge University Press. pp. 225–234. ISBN 978-0-521-51763-8.
  12. ^ Henningsen P, Zimmermann T, Sattel H (2003). "Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review". Psychosomatic Medicine. 65 (4): 528–533. doi:10.1097/01.psy.0000075977.90337.e7. PMID 12883101. S2CID 4138482.
  13. ^ Edwards MJ, Stone J, Lang AE (June 2014). "From psychogenic movement disorder to functional movement disorder: it's time to change the name". Movement Disorders. 29 (7): 849–852. doi:10.1002/mds.25562. PMID 23843209. S2CID 24218238.
  14. ^ Kranick S, Ekanayake V, Martinez V, Ameli R, Hallett M, Voon V (August 2011). "Psychopathology and psychogenic movement disorders". Movement Disorders. 26 (10): 1844–1850. doi:10.1002/mds.23830. PMC 4049464. PMID 21714007.
  15. ^ Ludwig L, Pasman JA, Nicholson T, Aybek S, David AS, Tuck S, et al. (April 2018). "Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies". The Lancet. Psychiatry. 5 (4): 307–320. doi:10.1016/S2215-0366(18)30051-8. PMID 29526521.
  16. ^ Aybek S, Vuilleumier P (2016). "Imaging studies of functional neurologic disorders". Functional Neurologic Disorders. Handbook of Clinical Neurology. Vol. 139. pp. 73–84. doi:10.1016/b978-0-12-801772-2.00007-2. ISBN 9780128017722. PMID 27719879.
  17. ^ "Imaging Study Provides New Biological Insights on Functional Neurological Disorder". Imaging Technology News. 2019-11-28. Retrieved 2022-01-08.
  18. ^ a b Bennett K, Diamond C, Hoeritzauer I, Gardiner P, McWhirter L, Carson A, Stone J (January 2021). "A practical review of functional neurological disorder (FND) for the general physician". Clinical Medicine. 21 (1): 28–36. doi:10.7861/clinmed.2020-0987. PMC 7850207. PMID 33479065.
  19. ^ D'Souza RS, Vogt MN, Rho EH (August 2020). "Post-operative functional neurological symptom disorder after anesthesia". Bosnian Journal of Basic Medical Sciences. 20 (3): 381–388. doi:10.17305/bjbms.2020.4646. PMC 7416177. PMID 32070267.
  20. ^ Espay AJ, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, et al. (September 2018). "Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders". JAMA Neurology. 75 (9): 1132–1141. doi:10.1001/jamaneurol.2018.1264. PMC 7293766. PMID 29868890.
  21. ^ Sonoo M (January 2004). "Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb". Journal of Neurology, Neurosurgery, and Psychiatry. 75 (1): 121–125. PMC 1757483. PMID 14707320.
  22. ^ Thenganatt MA, Jankovic J (27 August 2014). "Psychogenic tremor: a video guide to its distinguishing features". Tremor and Other Hyperkinetic Movements. 4: 253. doi:10.7916/D8FJ2F0Q. PMC 4161970. PMID 25243097.
  23. ^ Mellers JD (August 2005). "The approach to patients with "non-epileptic seizures"". Postgraduate Medical Journal. 81 (958): 498–504. doi:10.1136/pgmj.2004.029785. PMC 1743326. PMID 16085740.
  24. ^ Pick S, Rojas-Aguiluz M, Butler M, Mulrenan H, Nicholson TR, Goldstein LH (July 2020). "Dissociation and interoception in functional neurological disorder". Cognitive Neuropsychiatry. 25 (4): 294–311. doi:10.1080/13546805.2020.1791061. PMID 32635804. S2CID 220410893.
  25. ^ Wiginton K. "What Is Dissociation?". WebMD. Retrieved 2022-01-08.
  26. ^ Adams C, Anderson J, Madva EN, LaFrance WC, Perez DL (August 2018). "You've made the diagnosis of functional neurological disorder: now what?". Practical Neurology. 18 (4): 323–330. doi:10.1136/practneurol-2017-001835. PMC 6372294. PMID 29764988.
  27. ^ a b Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, Sharpe M (October 2005). "Systematic review of misdiagnosis of conversion symptoms and "hysteria"". BMJ. 331 (7523): 989. doi:10.1136/bmj.38628.466898.55. PMC 1273448. PMID 16223792.
  28. ^ Stone J, Hallett M, Carson A, Bergen D, Shakir R (December 2014). "Functional disorders in the Neurology section of ICD-11: A landmark opportunity". Neurology. 83 (24): 2299–2301. doi:10.1212/wnl.0000000000001063. PMC 4277679. PMID 25488992.
  29. ^ "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 2023-03-05.
  30. ^ Peeling JL, Muzio M (2022). "Conversion Disorder". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 31855394. Retrieved 2023-03-05.
  31. ^ Walzl D, Solomon AJ, Stone J (February 2022). "Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap". Journal of Neurology. 269 (2): 654–663. doi:10.1007/s00415-021-10436-6. PMC 8782816. PMID 33611631.
  32. ^ "Functional Neurological Disorder". NORD (National Organization for Rare Disorders). Retrieved 2022-01-20.
  33. ^ Espay AJ, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, et al. (September 2018). "Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders". JAMA Neurology. 75 (9): 1132–1141. doi:10.1001/jamaneurol.2018.1264. PMC 7293766. PMID 29868890.
  34. ^ Nielsen G, Stone J, Edwards MJ (August 2013). "Physiotherapy for functional (psychogenic) motor symptoms: a systematic review". Journal of Psychosomatic Research. 75 (2): 93–102. doi:10.1016/j.jpsychores.2013.05.006. PMID 23915764.
  35. ^ Edwards MJ (February 2016). "Functional neurological symptoms: welcome to the new normal". Practical Neurology. 16 (1): 2–3. doi:10.1136/practneurol-2015-001310. PMID 26769760. S2CID 29823685.
  36. ^ Stone J (March 2011). "Functional neurological symptoms". The Journal of the Royal College of Physicians of Edinburgh. 41 (1): 38–41, quiz 42. doi:10.4997/JRCPE.2011.110. PMID 21365066.
  37. ^ a b Tasca C, Rapetti M, Carta MG, Fadda B (2012-10-19). "Women and hysteria in the history of mental health". Clinical Practice and Epidemiology in Mental Health. 8: 110–119. doi:10.2174/1745017901208010110. PMC 3480686. PMID 23115576.
  38. ^ a b c Webster R. . www.richardwebster.net. Archived from the original on May 11, 2004. Retrieved 2016-02-21.{{cite web}}: CS1 maint: unfit URL (link)
  39. ^ Pringsheim T, Ganos C, McGuire JF, Hedderly T, Woods D, Gilbert DL, et al. (December 2021). "Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic". Movement Disorders. 36 (12): 2707–2713. doi:10.1002/mds.28778. PMC 8441698. PMID 34387394.
  40. ^ Olvera C, Stebbins GT, Goetz CG, Kompoliti K (November 2021). "TikTok Tics: A Pandemic Within a Pandemic". Movement Disorders Clinical Practice. 8 (8): 1200–1205. doi:10.1002/mdc3.13316. PMC 8564823. PMID 34765687.
  41. ^ Ghorayshi A, Bracken A (2023-02-13). "How Teens Recovered From the 'TikTok Tics'". The New York Times. ISSN 0362-4331. Retrieved 2023-05-19.
  42. ^ "Functional neurologic disorders/conversion disorder". Mayo Clinic.
  43. ^ Wessely S, White PD (August 2004). "There is only one functional somatic syndrome". The British Journal of Psychiatry. 185 (2): 95–96. doi:10.1192/bjp.185.2.95. PMID 15286058.
  44. ^ Kozlowska K, Sawchuk T, Waugh JL, Helgeland H, Baker J, Scher S, Fobian AD (2021). "Changing the culture of care for children and adolescents with functional neurological disorder". Epilepsy & Behavior Reports. 16: 100486. doi:10.1016/j.ebr.2021.100486. PMC 8567196. PMID 34761194.
  45. ^ O'Neal MA, Dworetzky BA, Baslet G (2021-01-01). "Functional neurological disorder: Engaging patients in treatment". Epilepsy & Behavior Reports. 16: 100499. doi:10.1016/j.ebr.2021.100499. PMC 8633865. PMID 34877516.

Further reading edit

  • Kwon D (November 2020). "A Disorder of Mind and Brain: A mysterious condition once known as hysteria is challenging the divide between psychiatry and neurology". Scientific American. 323 (5): 58–65 (60). A variety of conditions that have variously been termed "hysteria", "conversion disorder", or "psychosomatic illness" have most recently been given the name "functional neurological disorder (FND), [which] is deliberately neutral, simply denoting a problem in the functioning of the nervous system

April 14, 2024
functional, neurologic, disorder, this, article, require, cleanup, meet, wikipedia, quality, standards, specific, problem, comply, with, standards, medical, articles, medrs, medref, please, help, improve, this, article, december, 2022, learn, when, remove, thi. This article may require cleanup to meet Wikipedia s quality standards The specific problem is May not comply with standards for medical articles see WP MEDRS and WP MEDREF Please help improve this article if you can December 2022 Learn how and when to remove this template message Functional neurologic disorder or functional neurological disorder FND is a condition in which patients experience neurological symptoms such as weakness movement disorders sensory symptoms and blackouts As a functional disorder there is by definition no known disease process affecting the structure of the body yet the person experiences symptoms relating to their body function Symptoms of functional neurological disorders are clinically recognisable but are not categorically associated with a definable organic disease 1 2 The intended contrast is with an organic brain syndrome where a pathology disease process can be identified which affects the body s physiology Subsets of functional neurological disorders include functional neurological symptom disorder FNsD conversion disorder functional movement disorder and functional seizures The diagnosis is made based on positive signs and symptoms in the history and examination during consultation of a neurologist 3 Physiotherapy is particularly helpful for patients with motor symptoms weakness gait disorders movement disorders and tailored cognitive behavioural therapy has the best evidence in patients with dissociative non epileptic attacks 4 5 Contents 1 Signs and symptoms 1 1 Associated conditions 2 Causes 3 Diagnosis 3 1 ICD 11 diagnostic criteria 3 2 DSM 5 diagnostic criteria 3 3 Differential diagnoses 4 Treatment 5 Prevalence 6 History 6 1 Controversy 7 References 8 Further readingSigns and symptoms editThere are a great number of symptoms experienced by those with a functional neurological disorder While these symptoms are very real their origin is complex since it can be associated with severe psychological trauma conversion disorder and idiopathic neurological dysfunction 6 The core symptoms are those of motor or sensory dysfunction or episodes of altered awareness 7 8 9 10 Limb weakness or paralysis Blackouts also called dissociative or non epileptic seizures attacks these may look like epileptic seizures or faints Movement disorders including tremors dystonia spasms myoclonus jerky movements Visual symptoms including loss of vision or double vision Speech symptoms including dysphonia whispering speech slurred or stuttering speech Sensory disturbance including hemisensory syndrome altered sensation down one side of the body Dizziness and balance problemsAssociated conditions edit Epidemiological studies and meta analysis have shown higher rates of depression and anxiety in patients with FND compared to the general population but rates are similar to patients with other neurological disorders such as epilepsy or Parkinson s disease This is often the case because of years of misdiagnosis and accusations of malingering 11 12 13 14 Causes editA systematic review found that stressful life events and childhood neglect were significantly more common in patients with FND than the general population although some patients report no stressors 15 Converging evidence from several studies using different techniques and paradigms has now demonstrated distinctive brain activation patterns associated with functional deficits unlike those seen in actors simulating similar deficits 16 The new findings advance current understanding of the mechanisms involved in this disease and offer the possibility of identifying markers of the condition and patients prognosis 17 18 FND has been reported as a rare occurrence in the period following general anesthesia 19 Diagnosis editA diagnosis of a functional neurological disorder is dependent on positive features from the history and examination 20 Positive features of functional weakness on examination include Hoover s sign when there is weakness of hip extension which normalises with contralateral hip flexion 21 Signs of functional tremor include entrainment and distractibility The patient with tremor should be asked to copy rhythmical movements with one hand or foot If the tremor of the other hand entrains to the same rhythm stops or if the patient has trouble copying a simple movement this may indicate a functional tremor Functional dystonia usually presents with an inverted ankle posture or clenched fist 22 Positive features of dissociative or non epileptic seizures include prolonged motionless unresponsiveness long duration episodes gt 2minutes and symptoms of dissociation prior to the attack These signs can be usefully discussed with patients when the diagnosis is being made 23 24 25 26 Patients with functional movement disorders and limb weakness may experience symptom onset triggered by an episode of acute pain a physical injury or physical trauma They may also experience symptoms when faced with a psychological stressor but this isn t the case for most patients Patients with functional neurological disorders are more likely to have a history of another illness such as irritable bowel syndrome chronic pelvic pain or fibromyalgia but this cannot be used to make a diagnosis 27 FND does not show up on blood tests or structural brain imaging such as MRI or CT scanning However this is also the case for many other neurological conditions so negative investigations should not be used alone to make the diagnosis FND can occur alongside other neurological diseases and tests may show non specific abnormalities which cause confusion for doctors and patients 27 ICD 11 diagnostic criteria edit The International Classification of Disease ICD 11 have listed functional disorders within the neurology section for the first time 28 where they are named Dissociative neurological symptom disorder 29 DSM 5 diagnostic criteria edit The Diagnostic and Statistical Manual of Mental Illness DSM 5 lists the following diagnostic criteria for functional neurological symptoms conversion disorder One or more symptoms of altered voluntary motor or sensory function Clinical findings can provide evidence of incompatibility between the symptom and recognized neurological or medical conditions Another medical or mental disorder does not better explain the symptom or deficit The symptom or deficit results in clinically significant distress or impairment in social occupational or other vital areas of functioning or warrants medical evaluation 30 Differential diagnoses edit Multiple sclerosis has some overlapping symptoms with FND potentially a source of misdiagnosis 31 Treatment editTreatment requires a firm and transparent diagnosis based on positive features which both health professionals and patients can feel confident about 18 It is essential that the health professional confirms that this is a common problem which is genuine not imagined and not a diagnosis of exclusion 32 A multi disciplinary approach to treating functional neurological disorder is recommended Treatment options can include 33 Physiotherapy and occupational therapy Medication such as sleeping tablets painkillers anti epileptic medications and anti depressants for patients with depression co morbid or for pain relief Physiotherapy with someone who understands functional disorders may be the initial treatment of choice for patients with motor symptoms such as weakness gait walking disorder and movement disorders Nielsen et al have reviewed the medical literature on physiotherapy for functional motor disorders up to 2012 and concluded that the available studies although limited mainly report positive results 34 For many patients with FND accessing treatment can be difficult Availability of expertise is limited and they may feel that they are being dismissed or told it s all in your head especially if psychological input is part of the treatment plan Some medical professionals are uncomfortable explaining and treating patients with functional symptoms Changes in the diagnostic criteria increasing evidence literature about how to make the diagnosis and how to explain it and changes in medical training is slowly changing this 35 Prevalence editDissociative non epileptic seizures account for about 1 in 7 referrals to neurologists after an initial seizure and functional weakness has a similar prevalence to multiple sclerosis 36 History editFrom the 18th century there was a move from the idea of FND being caused by the nervous system This led to an understanding that it could affect both sexes Jean Martin Charcot argued that what would be later called FND was caused by a hereditary degeneration of the nervous system namely a neurological disorder 37 In the 18th century the illness was confirmed as a neurological disorder but a small number of doctors still believed in the previous definition 37 However as early as 1874 doctors including W B Carpenter and J A Omerod began to speak out against this other term due to there being no evidence of its existence 38 Although the term conversion disorder has been used for many years another term was still being used in the 20th century However by this point it bore little resemblance to the original meaning It referred instead to symptoms that could not be explained by a recognised organic pathology and was therefore believed to be the result of stress anxiety trauma or depression The term fell out of favour over time due to the negative connotations Furthermore critics pointed out that it can be challenging to find organic pathologies for all symptoms and so the practice of diagnosing that patients who had such symptoms were imagining them led to the disorder being meaningless vague and a sham diagnosis as it did not refer to any definable disease 38 Throughout its history many patients have been misdiagnosed with conversion disorder when they had organic disorders such as tumours or epilepsy or vascular diseases This has led to patient deaths a lack of appropriate care and suffering for the patients Eliot Slater after studying the condition in the 1950s was outspoken against the condition as there has never been any evidence to prove that it exists He stated that The diagnosis of hysteria is a disguise for ignorance and a fertile source of clinical error It is in fact not only a delusion but also a snare 38 In 1980 the DSM III added conversion disorder to its list of conditions The diagnostic criteria for this condition are nearly identical to those used for hysteria The diagnostic criteria were citation needed A The predominant disturbance is a loss of or alteration in physical functioning suggesting a physical disorder It is involuntary and medically unexplainableB One of the following must also be present A temporal relationship between symptom onset and some external event of psychological conflict The symptom allows the individual to avoid unpleasant activity The symptom provides opportunity for support which may not have been otherwise available During the COVID 19 pandemic neurologists noticed an increase in adolescents and young adults presenting with functional tic like behaviors to clinics around the world 39 Researchers believe that social media content regarding Tourette Syndrome influenced the sudden increase in functional tic like behaviors 40 The majority of the people who experienced functional tic like behaviors were female and neurologists have reported an overrepresentation of transgender and non binary identities within this group of adolescents and young adults 41 Today there is a growing understanding that symptoms are real and distressing and are caused by an incorrect functioning of the brain rather than being imagined or made up 42 Controversy edit There was historically much controversy surrounding the FND diagnosis Many doctors continue to believe that all FND patients have unresolved traumatic events often of a sexual nature which are being expressed in a physical way However some doctors do not believe this to be the case Wessely and White have argued that FND may merely be an unexplained somatic symptom disorder 43 FND remains a stigmatized condition in the healthcare setting 44 45 References edit Stone J Sharpe M Rothwell PM Warlow CP May 2003 The 12 year prognosis of unilateral functional weakness and sensory disturbance Journal of Neurology Neurosurgery and Psychiatry 74 5 591 596 doi 10 1136 jnnp 74 5 591 PMC 1738446 PMID 12700300 Aybek S Perez DL January 2022 Diagnosis and management of functional neurological disorder BMJ 376 o64 doi 10 1136 bmj o64 PMID 35074803 S2CID 246210869 Carey Katie Watson Meagan 2003 Reset amp Rewire The FND Workbook for Kids amp Teens Houston TX Illustrated Nurse Press p 4 ISBN 9798218232047 Lehn A Gelauff J Hoeritzauer I Ludwig L McWhirter L Williams S et al March 2016 Functional neurological disorders mechanisms and treatment Journal of Neurology 263 3 611 620 doi 10 1007 s00415 015 7893 2 PMID 26410744 S2CID 23921058 Goldstein LH Robinson EJ Chalder T Reuber M Medford N Stone J et al March 2022 Six month outcomes of the CODES randomised controlled trial of cognitive behavioural therapy for dissociative seizures A secondary analysis Seizure 96 128 136 doi 10 1016 j seizure 2022 01 016 PMC 8970049 PMID 35228117 Functional neurologic disorders conversion disorder Symptoms and causes Mayo Clinic Retrieved 2022 01 04 Functional neurological symptom disorder www medicalnewstoday com 2022 01 05 Retrieved 2022 01 08 Functional neurologic disorders conversion disorder Symptoms and causes Mayo Clinic Retrieved 2022 01 08 Functional Neurological Disorder Physiopedia Retrieved 2022 01 08 Symptoms Functional Neurological Disorder FND Retrieved 2022 08 18 Fiszman A Kanner AM 2010 Schachter SC LaFrance Jr WC eds Gates and Rowan s nonepileptic seizures 3rd ed Cambridge Cambridge University Press pp 225 234 ISBN 978 0 521 51763 8 Henningsen P Zimmermann T Sattel H 2003 Medically unexplained physical symptoms anxiety and depression a meta analytic review Psychosomatic Medicine 65 4 528 533 doi 10 1097 01 psy 0000075977 90337 e7 PMID 12883101 S2CID 4138482 Edwards MJ Stone J Lang AE June 2014 From psychogenic movement disorder to functional movement disorder it s time to change the name Movement Disorders 29 7 849 852 doi 10 1002 mds 25562 PMID 23843209 S2CID 24218238 Kranick S Ekanayake V Martinez V Ameli R Hallett M Voon V August 2011 Psychopathology and psychogenic movement disorders Movement Disorders 26 10 1844 1850 doi 10 1002 mds 23830 PMC 4049464 PMID 21714007 Ludwig L Pasman JA Nicholson T Aybek S David AS Tuck S et al April 2018 Stressful life events and maltreatment in conversion functional neurological disorder systematic review and meta analysis of case control studies The Lancet Psychiatry 5 4 307 320 doi 10 1016 S2215 0366 18 30051 8 PMID 29526521 Aybek S Vuilleumier P 2016 Imaging studies of functional neurologic disorders Functional Neurologic Disorders Handbook of Clinical Neurology Vol 139 pp 73 84 doi 10 1016 b978 0 12 801772 2 00007 2 ISBN 9780128017722 PMID 27719879 Imaging Study Provides New Biological Insights on Functional Neurological Disorder Imaging Technology News 2019 11 28 Retrieved 2022 01 08 a b Bennett K Diamond C Hoeritzauer I Gardiner P McWhirter L Carson A Stone J January 2021 A practical review of functional neurological disorder FND for the general physician Clinical Medicine 21 1 28 36 doi 10 7861 clinmed 2020 0987 PMC 7850207 PMID 33479065 D Souza RS Vogt MN Rho EH August 2020 Post operative functional neurological symptom disorder after anesthesia Bosnian Journal of Basic Medical Sciences 20 3 381 388 doi 10 17305 bjbms 2020 4646 PMC 7416177 PMID 32070267 Espay AJ Aybek S Carson A Edwards MJ Goldstein LH Hallett M et al September 2018 Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders JAMA Neurology 75 9 1132 1141 doi 10 1001 jamaneurol 2018 1264 PMC 7293766 PMID 29868890 Sonoo M January 2004 Abductor sign a reliable new sign to detect unilateral non organic paresis of the lower limb Journal of Neurology Neurosurgery and Psychiatry 75 1 121 125 PMC 1757483 PMID 14707320 Thenganatt MA Jankovic J 27 August 2014 Psychogenic tremor a video guide to its distinguishing features Tremor and Other Hyperkinetic Movements 4 253 doi 10 7916 D8FJ2F0Q PMC 4161970 PMID 25243097 Mellers JD August 2005 The approach to patients with non epileptic seizures Postgraduate Medical Journal 81 958 498 504 doi 10 1136 pgmj 2004 029785 PMC 1743326 PMID 16085740 Pick S Rojas Aguiluz M Butler M Mulrenan H Nicholson TR Goldstein LH July 2020 Dissociation and interoception in functional neurological disorder Cognitive Neuropsychiatry 25 4 294 311 doi 10 1080 13546805 2020 1791061 PMID 32635804 S2CID 220410893 Wiginton K What Is Dissociation WebMD Retrieved 2022 01 08 Adams C Anderson J Madva EN LaFrance WC Perez DL August 2018 You ve made the diagnosis of functional neurological disorder now what Practical Neurology 18 4 323 330 doi 10 1136 practneurol 2017 001835 PMC 6372294 PMID 29764988 a b Stone J Smyth R Carson A Lewis S Prescott R Warlow C Sharpe M October 2005 Systematic review of misdiagnosis of conversion symptoms and hysteria BMJ 331 7523 989 doi 10 1136 bmj 38628 466898 55 PMC 1273448 PMID 16223792 Stone J Hallett M Carson A Bergen D Shakir R December 2014 Functional disorders in the Neurology section of ICD 11 A landmark opportunity Neurology 83 24 2299 2301 doi 10 1212 wnl 0000000000001063 PMC 4277679 PMID 25488992 ICD 11 for Mortality and Morbidity Statistics icd who int Retrieved 2023 03 05 Peeling JL Muzio M 2022 Conversion Disorder StatPearls Treasure Island FL StatPearls Publishing PMID 31855394 Retrieved 2023 03 05 Walzl D Solomon AJ Stone J February 2022 Functional neurological disorder and multiple sclerosis a systematic review of misdiagnosis and clinical overlap Journal of Neurology 269 2 654 663 doi 10 1007 s00415 021 10436 6 PMC 8782816 PMID 33611631 Functional Neurological Disorder NORD National Organization for Rare Disorders Retrieved 2022 01 20 Espay AJ Aybek S Carson A Edwards MJ Goldstein LH Hallett M et al September 2018 Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders JAMA Neurology 75 9 1132 1141 doi 10 1001 jamaneurol 2018 1264 PMC 7293766 PMID 29868890 Nielsen G Stone J Edwards MJ August 2013 Physiotherapy for functional psychogenic motor symptoms a systematic review Journal of Psychosomatic Research 75 2 93 102 doi 10 1016 j jpsychores 2013 05 006 PMID 23915764 Edwards MJ February 2016 Functional neurological symptoms welcome to the new normal Practical Neurology 16 1 2 3 doi 10 1136 practneurol 2015 001310 PMID 26769760 S2CID 29823685 Stone J March 2011 Functional neurological symptoms The Journal of the Royal College of Physicians of Edinburgh 41 1 38 41 quiz 42 doi 10 4997 JRCPE 2011 110 PMID 21365066 a b Tasca C Rapetti M Carta MG Fadda B 2012 10 19 Women and hysteria in the history of mental health Clinical Practice and Epidemiology in Mental Health 8 110 119 doi 10 2174 1745017901208010110 PMC 3480686 PMID 23115576 a b c Webster R Sigmund Freud somatization medicine and misdiagnosis www richardwebster net Archived from the original on May 11 2004 Retrieved 2016 02 21 a href Template Cite web html title Template Cite web cite web a CS1 maint unfit URL link Pringsheim T Ganos C McGuire JF Hedderly T Woods D Gilbert DL et al December 2021 Rapid Onset Functional Tic Like Behaviors in Young Females During the COVID 19 Pandemic Movement Disorders 36 12 2707 2713 doi 10 1002 mds 28778 PMC 8441698 PMID 34387394 Olvera C Stebbins GT Goetz CG Kompoliti K November 2021 TikTok Tics A Pandemic Within a Pandemic Movement Disorders Clinical Practice 8 8 1200 1205 doi 10 1002 mdc3 13316 PMC 8564823 PMID 34765687 Ghorayshi A Bracken A 2023 02 13 How Teens Recovered From the TikTok Tics The New York Times ISSN 0362 4331 Retrieved 2023 05 19 Functional neurologic disorders conversion disorder Mayo Clinic Wessely S White PD August 2004 There is only one functional somatic syndrome The British Journal of Psychiatry 185 2 95 96 doi 10 1192 bjp 185 2 95 PMID 15286058 Kozlowska K Sawchuk T Waugh JL Helgeland H Baker J Scher S Fobian AD 2021 Changing the culture of care for children and adolescents with functional neurological disorder Epilepsy amp Behavior Reports 16 100486 doi 10 1016 j ebr 2021 100486 PMC 8567196 PMID 34761194 O Neal MA Dworetzky BA Baslet G 2021 01 01 Functional neurological disorder Engaging patients in treatment Epilepsy amp Behavior Reports 16 100499 doi 10 1016 j ebr 2021 100499 PMC 8633865 PMID 34877516 Further reading editKwon D November 2020 A Disorder of Mind and Brain A mysterious condition once known as hysteria is challenging the divide between psychiatry and neurology Scientific American 323 5 58 65 60 A variety of conditions that have variously been termed hysteria conversion disorder or psychosomatic illness have most recently been given the name functional neurological disorder FND which is deliberately neutral simply denoting a problem in the functioning of the nervous system nbsp Medicine portal Retrieved from https en wikipedia org w index php title Functional neurologic disorder amp oldid 1216701935, wikipedia, wiki, book, books, library,

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