Functional Neurologic Disorder

Functional Neurologic Disorder

What is functional neurologic disorder?
Who is more likely to get the disorder?
What are the types of functional neurologic disorder and their symptoms?
How are these disorders diagnosed and treated?
What are the latest updates?
What can I do?
Where can I find more information on functional neurological disorder?


What is functional neurologic disorder?

Functional neurologic disorder (FND), also called conversion disorder and functional neurologic symptom disorder, refers to a group of common neurological movement disorders caused by an abnormality in how the brain functions. FND is not caused by another disorder and there is no significant structural damage in the brain. The exact cause of FND is unknown. FND was thought to be a “conversion disorder” by Sigmund Freud because he believed it was a psychological disorder that converted into a neurological one.

Someone with FND can function normally, they just can’t at that moment. Their brain is unable to send and receive signals properly and there is a disconnection in the function of the lobes and emotional processing. Memory, concentration, cognition, and the processing of sensations also can be affected.

FND causes real symptoms that significantly interfere with how you function and cope with daily life. If you have FND, your unplanned movements and symptoms occur without you consciously starting them and are inconsistent and distinct from symptoms that are intentionally produced. FND can involve any part of your body. Symptoms may appear suddenly, increase with attention to them, and decrease when you are distracted.

FND can be difficult for you, your family, and doctors to understand. Early diagnosis and treatment can help lessen symptoms and aid in healing. .

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Who is more likely to get the disorder?

Anyone can develop FND.  An estimated 4 to 12 people per 100,000 will develop FND.  Fundamental causes may involve biological factors (such as early childhood trauma and early life stress, emotions, a propensity of anxiety, witness to violence, maltreatment, or childhood sexual abuse) or sociological factors (including interpersonal relationships and stress).  Some of these factors can trigger episodes of FND.  The disorder is more common in women and particularly in those who have a history of early life sexual trauma.  It can occur but is uncommon in children under age 10.  There appears to be an association with depression and anxiety, early life trauma, a dysfunctional family life, and even a dislike of job.
FND sometimes has a psychological cause as one of the relevant factors and may result from a somatic symptoms disorder (characterized predominantly by multi-system symptoms that are associated with distress and/or dysfunction and look like a physical illness). 

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What are the types of functional neurologic disorder and their symptoms?

FND has two primary categories:  psychogenic nonepileptic seizures and functional movement disorder.  There are many types of FND, with a diverse mix and range of neurologic symptoms and disorders.  For some people, symptoms are short-lived while for others they may last for years.
Psychogenic nonepileptic seizures (PNES) may look like generalized or other forms of epileptic seizures but are caused by brain dysfunction and not by abnormal electrical signaling in the brain.  You may have episodes of movement, sensation, and behavior similar to an epileptic seizure and may have a temporary loss of attention or memory lapse.  You also may have confusion or loss of consciousness without shaking.  You might feel “disassociated” (or somewhat disconnected) from thoughts or feelings or from the environment.  PNES can be stress-related, emotional, or psychological reactions to an inability to cope with a sudden or past event or events.  They mostly affect women and often begin in young adulthood.  Seizures may be frequent and prolonged.  With proper treatment, PNES may cease in some individuals or reduce in frequency.  Children and adolescents with PNES tend to have a higher rate of recovery.
Functional movement disorder (motor FND, affecting movement of the body) symptoms are common and may include:

  • Leg and arm weakness or paralysis
  • Tremor
  • Sudden, brief involuntary twitching or jerking of a muscle or group of muscles (called myoclonus)
  • Involuntary muscle contractions that cause slow repetitive movements or abnormal postures (called dystonia)
  • Problems with walking motion (gait), posture, or balance
  • Spasms and contractures (where the tendons become fixed in awkward or uncomfortable positions)
  • Muscle stiffness
  • Tics

Symptoms that affect other brain functions may include:

  • Speech difficulties, such as sudden onset of stuttering or trouble speaking
  • Problems with seeing or hearing
  • Pain (including chronic migraine)
  • Extreme slowness and fatigue
  • Numbness or inability to sense touch

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How are these disorders diagnosed and treated?

Diagnosis
No single test can confirm a diagnosis of FND.  A doctor will assess your health and medical and family history to rule out any neurological or other condition that may cause symptoms since FND can co-exist with other disorders.  A neurologist and a psychiatrist or psychologist may look for specific patterns of symptoms or signs to make a diagnosis.  Tests include physical, neurologic, and psychiatric exams, as well as imaging scans, in part to rule out other disorders, and examine symptoms such as tremor, weakness, walking, and vision.  Other tests such as electromyography (which records the electrical activity in muscles) and electroencephalography (which monitors the brain’s electrical activity) can help identify a movement disorder.  Video electroencephalography, which records what you are seeing or doing over a period of time (from several hours to days) while brain waves are being recorded until a seizure occurs, can help diagnose PNES and determine if other seizures that have unusual features are actually epilepsy.

Treatment
There are no specific treatments for FND but there are treatments for some of its symptoms.  A team of doctors and health professionals from various specialties work together to deliver a combination of treatments and comprehensive care.  Learning that your symptoms are real despite there not being an underlying medical disease can help you to better cope with the disease, become motivated to making change, and aid in recovery.  It’s possible to learn techniques to lessen your symptoms.  You and your medical team will schedule follow-up appointments.  Your family also should be involved to help understand FND, support you, and deal with your symptoms, treatment, and any stigma associated with the disorder.

Medications
Although there is no medication designed to specifically treat FND, medications are available to treat pain, anxiety, depression, insomnia, or headache that may occur.  Any antiseizure medications prescribed to treat nonepileptic seizures should be discontinued, as the attacks of PNES and those of epilepsy are not the same and are treated differently. 

Psychotherapy
Psychotherapy involves having you talk with a licensed and trained mental health professional about negative or troublesome emotions, behaviors, and thoughts.  Cognitive behavior therapy can help you modify your thought patterns to change emotions, mood, or behavior.  Psychodynamic therapy can help you identify and resolve patterns in your thoughts, beliefs, and emotions that may cause some of the neurological symptoms.  Relaxation and mindfulness exercises can help reduce stress.  Some individuals benefit from hypnosis to induce relaxation and lessen FND symptoms. 

Physical, speech, and occupational therapy
Physical therapy can treat muscle weakness or impaired movement.  You might need to relearn normal movement control and ways to avoid excessive attention to abnormal movements. Occupational therapy is designed to improve how you function and perform everyday tasks.  You might need speech therapy if your ability to speak or swallow is affected.

Redirecting attention
FND symptoms can strengthen with attention being pointed at your unwanted movement.  Redirecting attention from the abnormal movement, such as having a conversation while the movement is taking place or tapping by an unaffected arm or leg, can lessen your movement or other symptom.

Other forms of treatment may include transcranial magnetic stimulation (which uses magnetic fields generated outside your skull to stimulate nerve cells in the brain) to treat depression and anxiety and transcutaneous electrical stimulation (which uses low-voltage noninvasive electrical current to activate nerves) to relieve pain.  If you have PNES with warning signs you may be able to learn techniques to avoid symptoms.
Be aware that relapses and flare-ups often recur, despite treatment.

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What are the latest updates?

Several research projects on FND are funded by the National Institutes of Health, the leading supporter of biomedical research in the world.  Scientists at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS, the leading federal funder of research on the brain and nervous system) continue to investigate FND and treatment options.  Among NINDS research, scientists are studying the neurobiology of FND and nonepileptic seizures, as well as any clinical association of the effects of the COVID-19 pandemic on individuals with functional movement disorder. 

Scientists funded by the NIH are working to better understand the underlying neuropathology of FND and are using magnetic resonance imaging to develop neuroimaging biomarkers—signs that may indicate risk of developing a disease or be used to monitor its progression—for FND and nonepileptic seizures.  Among other research, investigators hope to develop a test to diagnose and better treat PNES and to test medications for PNES. 

Clinical research on FND can be found at ClinicalTrials.gov, a database of thousands of research studies in the U.S. and around the world.  Enter “functional neurological disorder” into the “Condition or disease” field to identify current and past trials.  You can also indicate country and state to find trials near you.

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What can I do?

Speak with your doctor
Speak honestly with your doctor or primary health care specialist about your symptoms and consider an evaluation by a neurologist and a psychiatrist.  Learning all you can about your disorder and knowing that your symptoms are real can help with your recovery and treatment options.  Speak with your doctor about resources and support groups for you and your family.  You may wish to being along a family member or friend to help you remember what the doctor said and for support.
Work with your care team to set treatment goals and effective outcome.

Lifestyle changes such as exercising, eating a balanced diet, participating in relaxation exercises, and getting enough sleep can help you reduce stress and anxiety. 

Prepare for your appointment
To prepare for your appointment, make a list of any symptoms you may be experiencing, a list of all of your medications, and a list of questions for your doctor.  Be sure to include any family history of illnesses or trauma.  Be prepared to answer questions about your past experiences, any mental health concerns you may have, and any recent social, emotional, or other life changes.  Bring a notepad to take notes.

Participate in a clinical trial or study
Clinical studies offer an opportunity to help researchers find better ways to safely detect, treat, or prevent disorders. All types of volunteers are needed—people with FND, caregivers, at-risk individuals, and healthy volunteers—of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them. For information about how you can contribute to the goal of finding a treatment or cure for FND, visit the “NIH Clinical Research Trials and You” webpage. For a comprehensive list of current and past trials on FND, visit www.clinicaltrials.gov and type in “functional neurological disorder.”

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Where can I find more information on functional neurological disorder?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424

The following organizations and resources help individuals, families, friends, and caregivers of people with FND:

FND Hope International
Email:  https://fndhope.org/contact/

neurosymptoms.org

Functional Neurological Disorders Society (for physicians and investigators)

You may be interested in the following information:

NINDS Epilepsy
NINDS Myoclonus
NINDS Dystonia online information
NINDS Tremor online information

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Online text updated August 2, 2021

"Functional Neurologic Disorder Fact Sheet", NINDS, Publication date August 2, 2021.

Back to Functional Neurologic Disorder Information Page

See a list of all NINDS disorders


Prepared by:

Office of Neuroscience Communications and Engagement
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

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