Demystifying Functional Neurological Disorders: What You Need to Know

Functional neurology is an emerging field that aims to better understand and address the complexities of neurological disorders. It focuses on identifying and treating the root causes of these conditions, rather than merely addressing the symptoms. By taking a comprehensive and integrative approach, functional neurology aims to optimize brain function and improve overall quality of life for patients dealing with a variety of neurological conditions.

Often, functional neurological disorders (FND) involve abnormalities in the way the brain processes information, leading to a range of symptoms such as movement control issues, altered awareness, or abnormal sensations. These disorders may not be caused by structural damage in the brain, but rather due to functional disruptions. FNDs can be challenging to diagnose and treat, but, with ongoing research, advancements in the field continue to offer hope for better understanding and management.

Key Takeaways

• Functional neurology focuses on identifying and treating the root causes of neurological disorders
• FND involves a range of symptoms due to abnormalities in brain function, not structural damage
• Ongoing research and advances in functional neurology offer hope for improved diagnosis and treatment options

Understanding Functional Neurology

Functional neurology focuses on the diagnosis and treatment of various neurological disorders that can affect an individual’s central and peripheral nervous systems. To gain a better comprehension of functional neurology, it’s essential to understand the vital components of the nervous system, such as the central and peripheral systems, neurons, and synapses.

Central and Peripheral Nervous System

The central nervous system (CNS) consists of the brain, brainstem, and spinal cord, which act as the main command center for the entire body. The CNS processes and integrates information from various sources and coordinates responses to different stimuli from these sources.

The peripheral nervous system (PNS), on the other hand, is a network of nerves extending all throughout the body. The PNS connects the CNS to the body’s organs, limbs, and tissues, transmitting signals between them. The peripheral nervous system is further divided into two main parts – the somatic nervous system responsible for voluntary movements and the autonomic nervous system, which manages involuntary functions such as respiration, digestion, and heart rate.

Neurons and Synapses

Neurons are the specialized cells within the nervous system designed to receive and transmit information both electrically and chemically. Neurons are the fundamental units of the brain and nervous system, responsible for receiving sensory input, relaying information between different brain regions, sending motor commands to the muscles and organs, and creating cognitive and emotional states.

Neurons can be classified into three main types:

1. Sensory (afferent) neurons: These neurons transmit information from sensory receptors to the CNS.
2. Motor (efferent) neurons: These neurons convey signals from the CNS to muscles and glands.
3. Interneurons: Located exclusively within the CNS, interneurons function as connectors between sensory and motor neurons.

Neurons communicate with each other through structures called synapses. A synapse is a small gap where the axon terminal of one neuron is closely apposed to the dendrite or cell body of another neuron. When an electrical signal (action potential) reaches the axon terminal, it triggers the release of neurotransmitters – specialized chemical messengers that cross the synaptic cleft and bind to receptors on the postsynaptic neuron. This binding can either excite or inhibit the postsynaptic neuron, modulating the transmission of information within the nervous system.

Functional neurology aims to address disorders and dysfunctions within these critical structures, helping to restore and improve normal brain function. By studying the nervous system, central nervous system, neurons, and synapses, experts can identify and address the root causes of various neurological conditions, leading to more targeted and effective treatments.

Functional Neurological Disorders

Functional neurological disorders (FNDs) encompass a range of conditions that involve the nervous system and result in symptoms that are not consistent with a neurological disease or other health issues. These disorders have a significant impact on a person’s quality of life and can be challenging to diagnose and treat. This section will discuss the primary categories of FND, including functional neurological disorder (FND), conversion disorder, and psychogenic nonepileptic seizures.

Functional Neurological Disorder (FND)

FND is a condition where a person develops symptoms that may appear suddenly and can involve any part of the body¹. This disorder is not a diagnosis of exclusion, but rather a rule-in diagnosis with available treatments². Early diagnosis and treatment can help lessen symptoms and aid in healing¹. FND is sometimes associated with co-occurring pathophysiologically defined diseases, making diagnosis and treatment more complex².

Conversion Disorder

Conversion disorder, a subtype of FND, is also known as functional movement disorder³. This condition results in symptoms such as tremors, jerky movements, or limb weakness that are not consistent with a neurological disease. Patients with conversion disorder may experience considerable distress and disability, and the symptoms are not intentionally faked. A proper diagnosis for conversion disorder relies on the identification of typical clinical features, rather than exclusion.

Psychogenic Nonepileptic Seizures

Psychogenic nonepileptic seizures (PNES) are a form of FND that closely resemble epileptic seizures but have no identifiable physiological cause. PNES are sometimes called functional seizures or nonepileptic seizures⁴. These seizures are typically triggered by emotional stress or other psychological factors. Treatment for PNES often involves addressing the underlying psychological issues through neurological rehabilitation, therapy, and stress management.

In summary, functional neurological disorders are complex conditions that can greatly affect a person’s quality of life. Proper diagnosis and prompt treatment can help alleviate symptoms and lead to better outcomes for those living with these disorders.

Signs and Symptoms

Functional Neurological Disorder (FND) presents with a wide range of symptoms that can be grouped into four main categories: Cognitive Symptoms, Motor Symptoms, Sensory Symptoms, and Emotional Symptoms. In this section, we will explore each of those categories to provide a clear understanding of the signs and symptoms associated with FND.

Cognitive Symptoms

Cognitive symptoms include issues with memory, attention, and processing information. Individuals with FND may experience memory lapses or difficulty concentrating. Additionally, they may struggle with performing tasks requiring complex thinking or problem-solving. Some common cognitive symptoms include:

• Memory lapses
• Difficulty concentrating and focusing
• Problems with problem-solving and complex tasks

Motor Symptoms

Motor symptoms are related to the control and coordination of muscles and movement. These symptoms can be either positive or negative, meaning they can result in either excessive movement or a lack of movement. Common motor symptoms in FND include:

• Weakness or paralysis
• Tremors or involuntary movements
• Movement disorders, like dystonia or chorea
• Coordination and balance issues

Sensory Symptoms

Sensory symptoms occur when an individual experiences altered sensation or perception in one or more of their senses. These can manifest as numbness, tingling, or burning sensations, among other sensations. Some frequently reported sensory symptoms include:

• Altered sensations like numbness, tingling, or burning
• Hypersensitivity to touch or temperature
• Dizziness or vertigo
• Visual disturbances

Emotional Symptoms

Emotional symptoms in FND can range from mood swings to anxiety and depression. It is essential to remember that these emotional symptoms are not the cause of FND but rather a result of the impact FND has on an individual’s overall well-being, and the underlying brain dysfunction. The following are some common emotional symptoms associated with FND:

• Anxiety or nervousness
• Depressive symptoms
• Mood swings
• Irritability or frustration
• Lack of motivation or enjoyment of life

It is important to recognize that these signs and symptoms can vary greatly from person to person. If you suspect you or a loved one may have FND, consult a healthcare professional for an accurate diagnosis and appropriate treatment options.

Diagnosis and Evaluative Procedures

Identification of Neurological Symptoms

In order to diagnose functional neurological disorders, it is crucial to identify the specific symptoms involved. These may go beyond the main functional symptoms and include issues such as sleep disturbances, fatigue, pain, and cognitive impairments¹. Recognizing these signs is important to develop an appropriate management plan for each individual patient.

Physical Examination

During the diagnostic process, a thorough physical examination is performed by a functional neurologist. This examination aims to reveal any observable inconsistencies between reported symptoms and clinical presentation. Positive signs such as specific patterns of movement or sensory abnormalities can contribute to the diagnosis². It is essential to involve the patient throughout the assessment, as establishing a good rapport and communication can significantly impact the successful management of their condition.

Imaging Scans

Although functional neurological disorders do not usually present structural abnormalities in the brain or nervous system, imaging scans such as magnetic resonance imaging (MRI) may still be utilized in the evaluation process. This is often done to rule out other neurological conditions that may be causing the symptoms³. While an imaging scan may not directly contribute to the diagnosis of a functional neurological disorder, it can help confirm the absence of alternative explanations for the symptoms.

Electroencephalography

Electroencephalography (EEG) is a non-invasive diagnostic technique that records electrical activity in the brain. It can be particularly useful in evaluating patients presenting with seizure-like symptoms. While EEG may not show specific abnormalities in functional neurological disorder cases, it can help differentiate between epileptic and non-epileptic events, thus narrowing down the diagnosis and guiding further management⁴. It is an essential tool in the comprehensive evaluation of patients presenting with neurological symptoms.

Quantitative Electroencephalography

Quantitative electroencephalography (qEEG), or brain mapping, utilizes standard EEG data to perform database comparisons resulting in topographical “maps”, often yielding invaluable information with regard to aberrant patterns of brain function often seen with the physical, cognitive, emotional, and metabolic symptoms those with FND struggle with.

Contributing Factors and Triggers

Environmental Factors

Exposure to environmental factors can play a significant role in the development of functional neurologic disorder (FND). These factors might include exposure to toxins, molds, pollutants, heavy metals, or infections. A person’s environment can also contribute to the development of FND indirectly through the influence of socio-economic status, access to healthcare, and availability of support systems.

Genetic Factors

While the exact role of genetics in FND is not well understood, it is believed that certain genetic factors may predispose an individual to develop the condition. Some studies suggest that there might be a genetic component linked to how our bodies respond to stress, making some individuals more susceptible to FND. Further research is needed to fully understand the role of genetics in the development of FND.

Stress and Psychological Factors

Stress and psychological factors play a significant role in the onset and progression of functional neurologic disorder. Psychosocial adversities, including stressful life events or unresolved emotional conflicts, may act as triggers for the manifestation of FND symptoms. Furthermore, psychological stressors such as anxiety and depression can exacerbate FND symptoms, making it difficult to manage the disorder effectively.

Comorbid Health Conditions

FND can be associated with various comorbid health conditions, which can further complicate diagnosis and treatment. For instance, individuals with FND may experience:

• Physical symptoms: Chronic pain, fatigue, and sleep disturbances.
• Mental health disorders: Anxiety, depression, or attachment deficits.

Addressing comorbid health conditions is vital for a holistic approach to managing FND, as it can help to reduce symptoms and improve overall well-being. Collaboration between healthcare providers is crucial for effective coordination of care for FND patients, taking into consideration both neurological and psychological aspects of the disorder.

Treatment and Management

Medication

While medications are not the primary treatment for functional neurological disorder (FND), they can be helpful in managing some associated symptoms such as anxiety or depression. A physician or psychiatrist may prescribe appropriate medications to address these specific concerns.

Functional Neurology

Functional neurology is the ideal treatment strategy for functional neurological disorders as it addresses imbalances in the nervous system that are at the root of most of the symptoms experienced by those with FND. While many therapeutic approaches are one dimensional, functional neurology addresses the neurological, physical, cognitive, emotional, metabolic, and lifestyle factors that impact brain and body health. 

Physical Therapy

Physical therapy plays a crucial role in the management of FND. It focuses on improving movement and reducing symptoms such as tremors, weakness, or coordination issues. A physical therapist will work with the patient to develop a tailored exercise program aimed at improving their functional abilities.

Occupational Therapy

Occupational therapy helps individuals with FND learn new ways to manage their daily activities. This may include adapting the environment, using adaptive equipment, or teaching new strategies for completing tasks. The goal is to work towards greater independence and participation in everyday life.

Speech Therapy

For those experiencing speech difficulties due to FND, speech therapy can be beneficial. A speech therapist will assess the patient’s communication skills and develop a customized treatment plan to improve speech, language, and swallowing abilities.

Multidisciplinary Approach

A multidisciplinary approach involves collaboration between different healthcare professionals, such as functional neurologists, physicians, therapists, and psychologists. This holistic approach ensures that each aspect of the patient’s condition is addressed and treated, leading to better outcomes.

Rehabilitation Services

Rehabilitation services are essential for patients with FND. These services may include physical, occupational, and speech therapy, as well as psychological support and cognitive rehabilitation. The main goal is to help individuals regain their functional abilities and improve their quality of life.

Stress Management

Given the psychological component of FND, learning effective stress management and self-regulation techniques can be highly beneficial. Techniques such as mindfulness, deep breathing exercises, and relaxation strategies can help individuals better cope with the challenges posed by their condition.

Nutrition and Diet

A well-balanced diet and proper nutrition can support overall health and well-being, which may have a positive impact on managing FND symptoms. Patients are encouraged to maintain a healthy lifestyle, including regular exercise and a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Laboratory testing can be implemented to drive nutritional recommendations.

Prognosis and Quality of Life

Recovery and Outcomes

Recovery from functional neurological disorders (FND) can vary greatly between individuals. In some cases, patients may experience significant improvement, while others may continue to struggle with the disorder. Various factors can influence the recovery process and outcomes, such as the severity and duration of symptoms, the presence of underlying psychiatric disorders, and access to appropriate treatment¹. FND symptoms can be associated with high levels of physical disability, similar to other neurological disorders².

Benefits of Treatment and Therapy

A range of therapeutic approaches exists to help patients manage FND, including functional neurological, physical, psychological, and occupational therapy³. These treatments aim to:

• Improve motor function and reduce disability
• Reduce the frequency and severity of seizure-type symptoms
• Address underlying psychiatric or emotional factors that may contribute to FND
• Enhance overall quality of life and daily functioning

Early intervention and multidisciplinary treatment plans can lead to better long-term outcomes for those suffering from FND⁴.

Living with Functional Neurological Disorders

Living with FND can be challenging, as it can affect various aspects of an individual’s life. However, there are ways to cope with the disorder and improve overall quality of life:

1. Seek proper medical care and participate in appropriate treatment programs.
2. Establish a support system, including family, friends, and medical professionals.
3. Educate yourself and your loved ones about FND to increase understanding and reduce misperceptions⁵.
4. Engage in healthy lifestyle habits, such as regular exercise, balanced nutrition, and quality sleep, to promote emotional and physical well-being.

By taking these steps, individuals can enhance their overall quality of life and better manage the challenges associated with functional neurological disorders.

Research and Advances

Systematic Reviews and Meta-Analyses

Over the past decade, there has been a renewed interest in functional neurological disorder (FND), a prevalent condition that lies at the intersection of neurology and psychiatry. This has led to significant advances in the field, as evidenced by multiple systematic reviews and meta-analyses. These studies have allowed us to gain a better understanding of FND and shed light on effective treatment approaches, ultimately improving patient outcomes.

Some of these systematic reviews focus on the efficacy of non-invasive brain stimulation therapies, such as transcranial magnetic stimulation, in treating FND patients. Furthermore, these reviews emphasize the importance of combining these therapies with other evidence-based treatments, such as cognitive-behavioral therapy and physical rehabilitation programs.

Neuroplasticity and the Brain’s Potential

Another critical area of FND research and advances is the study of neuroplasticity, which highlights the potential for the brain to reorganize and adapt itself in response to various stimuli. Understanding this brain’s ability to change and restructure itself can lead to the development of more targeted and effective treatments for FND and other neurological conditions.

At APEX Brain Centers, we harness the power of neuroplasticity to help our patients overcome FND symptoms. By using a combination of advanced therapies and evidence-based treatments, we encourage the brain’s potential to rewire and adapt, leading to significant improvements in our patients’ overall quality of life and well-being.

Through the continued study of FND and the application of systematic reviews, meta-analyses, and the understanding of neuroplasticity, we at APEX Brain Centers are dedicated to providing our patients with the most effective and individualized treatments possible. As research in the field continues to advance, we remain committed to staying abreast of the latest findings and incorporating them into our practice for the benefit of our patients.

FND and Specific Conditions

Functional Neurological Disorders and Epilepsy

Functional neurological disorders (FND) can sometimes be mistaken for epilepsy due to their overlapping symptoms, such as seizures. However, FND seizures, also known as psychogenic non-epileptic seizures (PNES), differ from epileptic seizures in their origin. While epilepsy originates from abnormal electrical activity in the brain, FND seizures result from an abnormality in how the brain functions. Understanding the differences between these two conditions is crucial for providing appropriate care and treatment to patients. Source

Functional Neurological Disorders and Multiple Sclerosis

Multiple sclerosis (MS) is a neurological condition that shares some similarities with FND. Both conditions can cause a wide range of neurological symptoms and have considerable variation in presentation. However, MS is an autoimmune disease that affects the central nervous system, while FND is rooted in how the brain processes information. It is crucial to distinguish between these disorders to ensure proper diagnosis and management. Source

Functional Neurological Disorders and Fibromyalgia

Fibromyalgia is a chronic pain disorder that can coexist with FND, as both conditions can cause similar symptoms, such as pain, fatigue, and cognitive difficulties. While fibromyalgia is characterized by widespread musculoskeletal pain and tender points, FND presents with abnormal movement, sensation, or other neurologic symptoms. A thorough assessment is essential to determine the presence of each condition and develop an appropriate treatment plan. Source

Functional Neurological Disorders and Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is another condition that can be associated with FND, as both can cause extreme fatigue and impact daily functioning. However, CFS is primarily characterized by unexplained, persistent, or relapsing fatigue that is disproportionate to exertion levels, while FND symptoms are primarily neurological in nature. Accurate diagnosis and treatment of these conditions are necessary to optimize patient care and improve overall quality of life. Source

Historical Context and Perspectives

Sigmund Freud and the Concept of Hysteria

Sigmund Freud, a well-known Austrian neurologist, played a significant role in shaping the understanding of functional neurological disorders. Based on his observations, he theorized that unconscious psychological conflicts could manifest as physical symptoms, a phenomenon he termed hysteria. Freud’s concept of hysteria suggested that the symptoms patients experienced were linked to emotional distress, rather than organic dysfunction.

Freud’s ideas on hysteria were predominantly influenced by Jean-Martin Charcot, a French neurologist, who had employed hypnosis to treat patients with hysteria. Freud used similar methods of hypnosis and developed psychoanalytic treatment approaches to explore underlying emotional issues that might have triggered these physical symptoms. However, this perspective of hysteria overshadowed non-psychological factors and shaped the field’s understanding of functional neurological disorders for several decades.

Evolution of the Field of Functional Neurology

The field of functional neurology has seen substantial advances since the days of Freud and his psychological-centered approach. In recent years, researchers and clinicians have begun to recognize the complex interplay between psychological, neurological, and physiological factors that contribute to functional neurological disorders (FND).

Modern advancements in diagnostic techniques and a more comprehensive understanding of the brain’s functioning have enabled clinicians to better identify and treat FND. It is now widely recognized that FND involves both physical and psychological factors, with the lines between mind and body often blurred. Current approaches to treating FND include addressing both these aspects and employ a multidisciplinary approach.

Functional neurology is thus at an exciting stage with new perspectives and treatments emerging. At APEX Brain Centers, we adopt a patient-centric, evidence-based approach and utilize advanced technologies to address the diverse factors contributing to FND symptoms in patients. Our goal is to demystify functional neurology and provide hope and support to those living with these challenging disorders.

Frequently Asked Questions

What is the role of a functional neurology specialist?

A functional neurology specialist focuses on understanding and treating disorders related to the nervous system. They aim to identify and address the root causes of neurological conditions, rather than just managing symptoms. By adopting a comprehensive approach that considers both physiological and psychological factors, functional neurology specialists can help patients achieve lasting improvements in their neurological health.

How can functional neurology help with anxiety?

Functional neurology can help those struggling with anxiety by targeting the underlying neurological factors that contribute to anxiety disorders. This approach may involve addressing imbalances in neurotransmitters or identifying and treating specific brain regions that are dysregulated in individuals with anxiety, as seen on qEEG. By getting to the root cause of the problem, patients can experience a reduction in anxiety symptoms and improve their overall quality of life.

How does chiropractic neurology differ from traditional neurology?

Chiropractic neurology, also known as functional neurology, differs from traditional neurology in its approach to assessment and treatment. Chiropractic neurologists emphasize non-invasive, drug-free interventions to treat neurological conditions. The modalities used may include dietary and lifestyle changes, chiropractic adjustments, and other therapies to stimulate and enhance brain function.

Can chiropractic care address neurological issues?

Yes, chiropractic care can address a range of neurological issues. By focusing on the relationship between the spine and nervous system, chiropractic adjustments can help improve nervous system function, reduce inflammation, and promote overall neurological health. Treatment plans are tailored to the individual’s needs and may incorporate other complementary therapies for optimal results.

What techniques do functional neurologists use?

Functional neurologists use a variety of techniques to assess and treat neurological conditions. Some common methods include neurocognitive testing, balance and coordination assessments, qEEG brain mapping techniques, eye movement testing and rehabilitation, laboratory analysis, and clinical examinations of reflexes and sensory function. In addition to chiropractic adjustments, treatment may involve non-invasive brain stimulation, low-level laser therapy, hyperbaric oxygen therapy, nutritional counseling, targeted sensory modalities, and more to improve brain function.

How can holistic neurology contribute to patient outcomes?

Holistic neurology takes a comprehensive approach to assessing and treating neurological conditions. By considering the whole person, including factors such as nutrition, lifestyle, and emotional wellbeing, this approach aims to optimize patients’ overall health and resilience. By addressing the underlying issues that contribute to neurological problems, holistic neurology can help patients achieve lasting improvements in their neurological health and overall quality of life.

Footnotes

1. National Institute of Neurological Disorders and Stroke ↩ ↩² ↩³ ↩⁴
   
2. Recognising and explaining functional neurological disorder | The BMJ ↩ ↩² ↩³ ↩⁴
   
3. Diagnosis and management of functional neurological disorder ↩ ↩² ↩³
   
4. Functional Neurologic Disorder: What You Should Know – Healthline ↩ ↩² ↩³
   
5. Functional Neurologic Disorder | National Institute of Neurological … ↩