Functional neurological symptom disorder

Functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts. The brain of a patient with Functional Neurological Disorder is structurally normal, but functions incorrectly. In broad terms there is a problem with the patient's central nervous system, which is not sending and receiving signals correctly. Other terms for functional neurological disorder represent changing ideas and attitudes to these disorders and include functional neurological symptom disorder (FNsD), conversion disorder, psychogenic movement disorder/non-epileptic seizures. The cause of functional neurological disorders is considered to be multifactorial, which means many different factors can contribute to the development of the disorder. With greater understanding of the brain most diseases including functional neurological disorders should be thought of as having biological, psychological and social components (the biopsychosocial disease model). Functional neurological disorders are common in neurological services, accounting for up to one third of outpatient neurology clinic attendances, and associated with as much physical disability and distress as other neurological disorders. The diagnosis is made based on positive signs and symptoms in the history and examination during consultation of a neurologist (see below). Assessment demonstrates that normal function of the nervous system is possible. The best evidence for treatment for functional neurological disorders from recent studies suggest that physiotherapy and/or psychological therapy can both be helpful depending on the individual patient. Physiotherapy is particularly helpful for patients with motor symptoms (weakness, gait disorders, movement disorders) and tailored cognitive behavioural therapy has the best evidence in patients with dissociative (non-epileptic) attacks.