Functional neurological disorder or FND is a condition where someone has neurological symptoms but may not have physical changes in their brain or nerves.
This is sometimes described as a problem with brain software rather than hardware. There is no physical damage to the nerve, but your brain is processing nerve signals in an inappropriate way. This faulty information processing leads to the symptoms associated with FND.
FND symptoms might include tremor, fixed postures, jerks or muscle weakness. Some people with FND have problems walking, speech disturbance, or dizziness. FND symptoms feel very real and they may be disabling. It is possible to have MS and also have FND or functional symptoms as well.
Although FND can be hard to diagnose, it is treatable. With therapist support, your brain can be retrained to operate your body in a more comfortable and natural way.
Functional neurological disorder (FND) is a problem with the information processing rather than the delivery of messages between the brain and body. The problems happen in a level of the brain that you cannot control. FND can be triggered by stress, anxiety or a traumatic event or accident.
People with a neurological condition like MS are more likely to get FND or functional symptoms than other people. Some people may have few symptoms, and some people may have many. You might not have a full diagnosis of FND, but your doctor may talk to you about having functional symptoms or functional overlay alongside your MS symptoms.
Functional symptoms vary from person to person. They include things like arm or leg weakness, spasms and seizures. Other symptoms like fatigue or pain are not directly caused by FND, but are often found alongside it.
A diagnosis of FND should be made because you have one or more clinical features that a specialist can recognise as typical of FND. It shouldn’t be made just because tests for other neurological conditions are normal.
A clinical feature is a distinctive way that your symptom presents that is unique to FND. For example, it could be that your eyes close during seizures, or your limb weakness briefly disappears during certain physical tests. Clinical features are what specialists use to identify FND from other neurological conditions with similar symptoms.
To make a diagnosis of functional symptoms or FND, your neurologist will examine you carefully and see what happens to your symptoms under certain conditions such as walking or performing tasks with your hands.
Functional symptoms and FND are usually treated with help from physiotherapists and occupational therapists. The aim is to retrain your brain to interpret and process the nerve signals to and from your body. This should mean that you can reverse the symptoms and regain control of your movements.
If your functional symptoms have been triggered by emotional or psychological events, then you may be offered psychotherapy to explore and manage those feelings. This may include working through painful or frightening experiences, but this will only be done with your consent and at your pace.
You may also be encouraged to learn grounding and relaxation techniques, to help you manage your functional symptoms at home.
Many people with FND or functional symptoms make a full recovery. Some people may recover but retain a tendency to express stress as physical symptoms from time to time. Some people find that recovery is more gradual. For most people, understanding what is causing their symptoms helps them live with and manage them.
Things to remember about functional neurological symptoms or FND:
- Your neurologist should be able to make a confident diagnosis based on clinical features of your symptoms.
- Functional symptoms are not caused by your MS but may have been triggered by physical or psychological factors.
- FND and functional symptoms are common in people with MS.
- Functional symptoms can be treated and reversed with therapy to improve your control of the affected parts of your body.
