Functional Neurological Disorders: Symptoms, Causes And Treatment

Functional neurological disorders

Functional neurological disorders are one of the most enigmatic disorders of the brain. It is not very well known what the cause is, because they have neurological symptoms but the brain seems to be fine. Despite this, the patient’s symptoms are totally real and cause discomfort that, of course, is also very real.

Although not much is known about these disorders, it is believed that they are the second cause of consultation in neurology, which makes them very common conditions but which, ironically, remain very little known in the general public and those who Sufferers often suffer from symptoms of loneliness and misunderstanding.

Here Let’s talk about what functional neurological disorders areits main symptoms, what are the causes that have been considered as possible and, also, help to make visible a disorder whose awareness is still low.

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What are functional neurological disorders?

The term “functional neurological disorders” is a relatively recent and broad expression used to describe the conditions in which neurological symptoms occur but cannot be explained due to a disease of the nervous system or other organic problem. These have received multiple names throughout history: hysterical neurosis, conversion disorders, psychosomatic, psychogenic, medically unexplained disorders…

Normally, these disorders affect movements and senses, altering the ability to walk, swallow, see or hear. The severity of the symptoms can vary greatly from patient to patient, and their duration is also highly variable.

The patient has no control over these symptoms nor does he intentionally produce them.. Although the cause of it is not known, the symptoms that the patient suffers are very real and cause him a lot of discomfort, in addition to interfering with his daily life.

Functional neurological disorders can be triggered by a neurological disorder or by a reaction to stress, physical trauma, or the experience of a psychologically traumatic situation, although this is not always the case. These disorders are related to the way the brain works, and not to damage to brain structureas would occur in a stroke, multiple sclerosis, a craniocerebral injury or a brain infection.

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Symptoms

As we mentioned, the symptoms and signs of functional neurological disorders vary greatly depending on the case, but what they have in common is that they are serious enough to cause deterioration in the patient’s quality of life, emotional distress, and require a medical evaluation. The symptoms associated with these problems can affect the movement and functioning of the body, in addition to altering the senses..

Among the signs and symptoms that affect the functioning and movement of the body we find:

  • Weakness or paralysis
  • Tremors
  • Walking problems
  • Loss of balance
  • Difficulty to swallow
  • Globus pharyngeus (feeling of a lump in the throat)
  • Seizures or episodes of shaking and an apparent loss of consciousness
  • Episodes of unresponsiveness
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And among the signs and symptoms in which the senses are affected we have:

  • Numbness of the extremities
  • Sensation of loss of sensitivity to touch
  • Speech problems: stammering or inability to speak
  • Vision problems: double vision or blindness
  • Hearing problems: hearing worse or deafness
Causes of functional neurological disorders
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Causes

As we have anticipated, The exact cause behind functional neurological disorders is an enigma. There are several hypotheses and theories about what happens at the brain level to cause the symptoms associated with this type of disorders, very complex explanations that cover several mechanisms that can be different depending on the type of functional neurological disorder of each patient. .

The symptoms of functional neurological disorders can appear suddenly after a very stressful episode. Also They can manifest after receiving physical trauma or having gone through a very difficult emotional situation..

Furthermore, it has been hypothesized about the influence of triggers that induce changes or alterations in the functioning of the brain at a structural, cellular or metabolic level. Despite all these proposals as possible causes behind functional neurological disorders, it is not always possible to identify the trigger of the symptoms.

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Risk factor’s

The fact that it is not known with certainty what the causes behind functional neurological disorders are has not been an impediment to identifying the risk factors that increase the chances of suffering from one of them. Among the factors that can increase the risk of presenting this type of disorders are:

  • Suffering from a neurological disease or disorder (e.g. migraines, epilepsy…)
  • Physical trauma, emotional trauma, or significant major stress
  • Suffering from a mental disorder: anxiety disorder, personality disorders…
  • Family history of functional neurological disorder
  • History of abandonment or sexual and/or physical abuse in childhood
  • To be a woman

Diagnosis

As of today, there are not many standard tests for the diagnosis of functional neurological disorders. Generally, The diagnosis is made by evaluating the symptoms that the patient reports suffering, ruling out any neurological disease or other condition that could cause them..

Functional neurological disorders are diagnosed by evaluating which symptoms are present and which are absent. That is, it looks at whether certain specific patterns of signs and symptoms typical of a neurological disorder are present, but it also assesses whether structural alterations are not shown using neuroimaging techniques such as magnetic resonance imaging (MRI) or abnormalities in an electroencephalogram.

Since there is an apparent neurological alteration, the participation of a neurologist is necessary during the diagnosis of this type of disorder, but the collaboration of a psychiatrist and a clinical psychologist can also be included. The doctor can use several terms to describe the same situation: functional neurological disorders, functional neurological symptom disorder or hysterical neurosis (the latter is currently disused).

Typically, the term “functional neurological disorders” is preferred because it can be used to specify the type of functional neurological symptom that the patient suffers from. For example, if the patient has problems walking, the doctor will name it as a case of functional gait disorder, or if there are problems swallowing, he or she may call it functional swallowing disorder.

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The evaluation process includes the following.

1. Physical examination

The doctor examines the patient and asks questions about his or her health and what signs or symptoms have been bothering him or her in recent weeks. In this phase, tests are applied to rule out other medical conditions. that could explain the symptoms for which the patient came for consultation. The type of test applied will depend on what signs and symptoms the affected person manifests.

2. Psychiatric examination

If psychological problems occur, the neurologist can refer the patient to a mental health professional., both a psychiatrist and a clinical psychologist. The professional will ask the patient questions about her feelings, thoughts and behavior, identifying and analyzing psychological symptoms that could be related to a supposed case of functional neurological disorder.

The professional will make the diagnosis based on the clinical criteria of the DSM-5. In this manual, functional neurological disorders are called conversion disorder and also functional neurological symptom disorder. Its diagnostic criteria are the following:

  • One or more symptoms of alteration of voluntary motor or sensory function.
  • Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
  • The symptom or deficiency is not better explained by another medical or mental disorder.
  • The symptom causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The DSM-5 itself indicates that it is necessary to specify the type of main symptom that affects the patient:

  • With weakness or paralysis
  • With abnormal movement (eg, tremor, dystonic movement, myoclonus, gait disorder)
  • With swallowing symptoms
  • With speech symptom (e.g., dysphonia, poor articulation)
  • With attacks or convulsions
  • With anesthesia or sensory loss
  • With special sensory symptoms (e.g., visual, olfactory, or auditory disturbance)
  • With mixed symptoms

Specify if:

  • Acute episode: Symptoms present for less than six months.
  • Persistent: Symptoms for six months or more.

Specify if:

  • With psychological stress factor (specify stress factor)
  • No psychological stress factor

Treatment

Treatment will depend on the type of functional neurological disorder, the symptoms and signs that the patient presents. Either way, The most useful thing for this type of disorders is that the treatment is carried out by a multidisciplinary team of professionals.made up of neurologists, psychiatrists and psychologists, as well as speech therapists, physiotherapists and occupational therapists depending on what the patient’s particular case requires.

It is essential to educate the patient, explaining and ensuring that they understand what functional neurological disorders are. The professional who treats you must show you that he understands that your symptoms are real, that they are not an invention or an exaggeration, but that the organic cause is not so clear.

Sometimes, symptoms can improve after giving the patient an extensive explanation of their disorder, making them understand that they do not have a serious, life-threatening medical problem, despite bothersome symptoms.

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Also It is important to involve the familymaking them understand that their loved one’s symptoms are real, and that they should provide support and understand that it is not a simulation to get attention or that they are complaining about nothing.

We find several therapies used in the treatment of neurological disorders, each one used according to the needs of the particular case:

1. Occupational therapy

Occupational therapy can improve symptoms associated with movement and prevent possible complications. By regularly moving arms and legs, you avoid muscle stiffness and weakness that can occur in cases of paralysis or loss of mobility. The gradual increase in exercise provides greater autonomy to the patient.

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2. Speech therapy and the oral apparatus

With the help of a speech therapist they can be addressed symptoms including problems speaking or swallowing.

3. Stress reduction and distraction techniques

Several techniques can be used aimed at reducing the patient’s stress. Among these techniques we find progressive muscle relaxation, breathing exercises and physical exercise.

On the other hand, distraction techniques can also serve to improve the patient’s quality of life, stopping paying attention to your annoying somatic symptoms and occupying your mind on other tasks. You can do this by listening to music, talking to other people, or intentionally changing the way you walk and move.

4. Cognitive-behavioral therapy

In order to manage the psychological problems associated with functional neurological disorder, cognitive-behavioral psychotherapy can be used. Through this modality of therapy you become aware of imprecise or negative thoughts that may have had a harmful influence in certain situations that the patient has had to face.

Cognitive-behavioral therapy is used to treat other mental health disorders that may have aggravated the symptoms of the neurological disorder. Among them, we would find anxiety, depression, personality disorders, bipolar disorder…

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5. Pharmacology

Medications are considered ineffective in the treatment of functional neurological disorders. In fact, the US Food and Drug Administration (FDA) does not approve any medication specifically as a treatment for these neurological conditions.

Nevertheless, It is considered that antidepressants could be useful in the event of depression or a mood disorder that influences the severity of the disorder.

Visibility of these disorders

Although it is considered to be the second cause of consultation in neurology services, functional neurological disorders have little public recognition, both in medical circles and among the general population, which means that in many cases these disorders they suffer from loneliness and incomprehension.

Just because their cause is unclear does not mean they are not real.and in fact those who suffer from them may have a disability and a deterioration in quality of life similar to that caused by diseases such as Parkinson’s disease or epilepsy.

Since 2012, the International Day of Functional Neurological Disorders has been celebrated on April 13, a celebration that aims to support people affected by these disorders and raise awareness in society about their existence. This is intended to combat the stigma that patients with functional neurological disorders often suffer, since the belief is still widespread that if there is no organic cause to explain it, the symptoms are simulation.