April is World FND Month
by Angela Warner
Do you know which neurological condition is the second most common reason for a neurological outpatient visit (after headache/migraine)? Would you say MS or maybe Parkinson's? In fact, it is functional neurological disorder (FND), but don't feel bad if you've never heard of it - most people haven't. That's why FND Hope International is on a mission to raise awareness of the disorder, including designating April as World FND Month.
In FND there is a problem with the functioning of the nervous system and how the brain and body send and/or receive signals. Research suggests that
FND accounts for one sixth of neurological diagnoses, which means FND is as common as multiple sclerosis or Parkinson’s disease. FND can be experienced as a standalone disorder, or in conjunction with another neurological disorder.
FND patients can experience a wide range and combination of symptoms that are physical, sensory and/or cognitive, including:
1. Motor dysfunction: limb weakness/paralysis, tremour, dystonia, myoclonus, gait problems and problems with speech.
2. Sensory dysfunction: altered sensation (numbness, tingling or pain, often occurring on one side of the body) and visual symptoms (loss of vision or double vision).
3. Episodes of altered awareness: seizures, blackouts and syncope (fainting).
In FND, symptoms become ‘stuck’ in a ‘pattern’ in the nervous system, resulting in altered brain functioning. The aim of treatment is to ‘retrain the brain’, by unlearning abnormal and dysfunctional movement patterns that have developed, and relearning normal movement. Psychological therapies can also be used, in particular for functional seizures.
If you're interested in learning more, the most comprehensive guide is neurosymptoms.org, created by Prof. Jon Stone.
References
National Organization for Rare Disorders (NORD) website (https://rarediseases.org/rare-diseases/fnd/)
Stone J, Carson A, Duncan R, et al: Who is referred to neurology clinics? the diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010 Nov; 112(9):747-51. DOI: 10.1016/j.clineuro.2010.05.011. Epub 2010 Jun 19.
Lin D, Castro P, Edwards A, et al: Dissociated motor learning and de-adaptation in patients with functional gait disorders. Brain 2020 Aug; 143(8). DOI: 10.1093/brain/awaa190
Aybek S, Lidstone S C, Nielsen G, et al: What Is the Role of a Specialist Assessment Clinic for FND? Lessons From Three National Referral Centers. Journal of Neuropsychiatry 2019 Oct; 32(1):appi.neuropsych. DOI: 10.1176/appi.neuropsych.19040083
Nicholson C, Edwards M J, Carson A J, et al: Occupational therapy consensus recommendations for functional neurological disorder July 2020Journal of Neurology Neurosurgery & Psychiatry 2020 Jul; 91(10):jnnp-2019-322281. DOI: 10.1136/jnnp-2019-322281
Goldstein L H, Robinson EJ, Mellers J, et al: Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. The Lancet Psychiatry 2020 May; 7(6):491-505. DOI: 10.1016/S2215-0366(20)30128-0. LicenseCC BY 4.0