What is Functional Neurological Disorder?

Functional Neurological Disorder (FND) is a collection of symptoms such as blackouts, paralysis and atypical movements that suggest the presence of an underlying neurological condition, yet cannot be explained by disease or anatomical abnormalities. FND was formerly called Psychogenic Non-Epileptic Seizures (PNES).

Symptoms

The two most common symptom groups of FND are Functional Motor Disorders (FMD) and Dissociative Attacks/Events (DA).

Functional Motor Disorders

These may include a range of sometimes debilitating symptoms, such as:

  • limb weakness 
  • tremor (shaking)
  • dystonia (abnormal posturing)
  • gait disorders (limb movements)
  • dysphagia (difficulty swallowing)

Dissociative Attacks/Events

Dissociative Attacks involve altered movements, sensations and states of consciousness that can closely resemble epileptic seizures but are not caused by abnormal electrical discharges in the brain or abnormal brain anatomy. 

Symptoms may include: 

  • excessive movements of the limbs, trunk and head 
  • dystonia (abnormal posturing) 
  • tremor (shaking)
  • altered/loss of consciousness

The driving force behind these attacks is dissociation. This is a response to a combination of physical (including sensory overload), mental and social stressors. Dissociation involves feeling disconnected from the body (e.g. thoughts, feelings and sensations) and/or disconnected from the immediate environment. People often describe dissociation as feeling spacey, zoning out, or as though their brain has shut down. Some people experience warning signs or triggers before episodes however for others they can seem to happen automatically.

Other symptoms

People who have a functional neurological disorder can often have other symptoms such as: 

  • chronic pain
  • fatigue 
  • difficulty with cognitive function (i.e. poor memory, concentration)
  • sensory symptoms such as numbness and/or tingling 

What causes FND?

The exact cause of FND is not entirely known and no single process has been identified as being sufficient to explain the onset of FND. Biological, psychological and social factors can interact and cause vulnerabilities, triggers and ongoing factors that contribute to FND. However, there are proven and effective treatments available.

Due to the very different treatment pathways for both dissociative attacks and epilepsy, it is very important to distinguish them as two very different issues. However, having one condition does not exclude the other from developing. People with dissociative attacks may also develop epilepsy or other diseases in their lifetime.

Treatment

After receiving a diagnosis of FND from your doctor you may be treated by a multidisciplinary team of health professionals including physiotherapists, psychologists, occupational therapists, psychiatrists, speech pathologists, social workers and nurses. The first step in treatment is to develop a good understanding of FND and to ask any questions you may have to your treating team. It is also good to educate your support networks about FND as your family and friends will be able to help support you better during your treatment journey. It is important to work together with your team to set treatment goals and objectives to maximise good treatment outcomes.

Functional Neurological Disorder resources