Exploring functional neurological disorder

Functional neurological disorder (FND) is a complex condition where the brain struggles to send and interpret signals correctly, leading to symptoms that mimic other neurological conditions. The condition can be challenging to diagnose and manage. We speak to leading consultant neurologist Dr Abhijit Das, who provides clarity and hope for those affected by this disorder.

What is functional neurological disorder?

Functional neurological disorder (FND) is a medical condition where individuals experience neurological symptoms—such as weakness, movement difficulties, or blackouts—that cannot be explained by structural or physical damage in the nervous system. In other words, although the brain and nerves appear physically healthy in scans or other tests, the brain’s ability to send and receive signals is disrupted. FND affects people differently, and symptoms can vary widely in severity and duration.

How does FND affect the body and mind?

People with FND may experience symptoms that resemble other neurological conditions like multiple sclerosis or epilepsy. Common symptoms include tremors, muscle weakness, paralysis, difficulty walking, and episodes that resemble epileptic seizures. Sensory symptoms, such as numbness, tingling, or loss of sensation, are also common. Some patients may also experience problems with vision or speech.

It is important to understand that these symptoms are real and can be distressing. They are not “all in the mind” or imaginary; instead, they result from functional changes in the nervous system, meaning that the brain is not processing signals as it should. This can sometimes lead to psychological stress or anxiety, both of which may worsen the symptoms, creating a challenging cycle.

What causes FND?

The exact cause of FND is not yet fully understood, but it is thought to result from a combination of biological, psychological, and social factors. In some cases, FND may develop following a physical injury, infection, or another health event. Emotional trauma or stressful life experiences may also contribute to the onset of symptoms.

There is no single “type” of person who develops FND. People of all ages, backgrounds, and health histories can be affected. Researchers are exploring how brain function, past experiences, and even genetics might play a role in FND, but more research is needed to fully understand its causes.

How Is FND diagnosed?

Diagnosing FND requires a careful assessment by a neurologist or another specialist familiar with the disorder. This often involves a detailed physical examination and may include neurological tests. Sometimes, people undergo tests like MRI scans to rule out other neurological conditions that might mimic FND. For example, if a patient is experiencing tremors, the neurologist may use specific movements during the exam to see if the tremors behave in a way typical for FND.

One of the key diagnostic features in FND is that the symptoms may improve or change when a patient is distracted or relaxed, which can help distinguish FND from other neurological conditions.

What are the treatment options for FND?

Treatment for FND varies based on symptoms and individual needs. Many patients benefit from a multidisciplinary approach, where professionals like neurologists, psychologists, and physiotherapists work together. Treatment often involves physiotherapy to address movement symptoms and cognitive behavioural therapy (CBT) to help manage stress, anxiety, and other mental health concerns.

For those experiencing symptoms like tremors or seizures, specific strategies in physiotherapy can help retrain the brain’s signalling pathways. Some patients find that learning relaxation techniques and mindfulness can also help reduce symptom frequency and severity.

FND can be a challenging condition, but with proper care and a supportive treatment team, many people experience improvement in their quality of life and a reduction in symptoms.