Symptoms
FND symptoms are highly variable and can affect any part of the nervous system. Common symptoms include:
Motor symptoms: Weakness or paralysis, tremors, jerks, abnormal gait (walking), muscle spasms, dystonia (sustained muscle contractions).
Sensory symptoms: Numbness, tingling, pain, altered vision (blurring, double vision), hearing loss, altered taste or smell.
Seizures: Functional seizures (also called psychogenic non-epileptic seizures or PNES) that resemble epileptic seizures but without the abnormal brain electrical activity.
Speech and swallowing difficulties: Slurred speech, difficulty swallowing (dysphagia), hoarseness.
Cognitive symptoms: Difficulties with memory, concentration, or thinking.
Other symptoms: Fatigue, dizziness, bowel and bladder dysfunction.
Causes
The exact cause of FND is not fully understood, but it's thought to involve a combination of factors:
Psychological factors: Stress, anxiety, depression, trauma (physical or emotional abuse, neglect, etc.), post-traumatic stress disorder (PTSD).
Neurological factors: Pre-existing neurological conditions, genetics, brain injury, or inflammation may increase susceptibility.
Physiological factors: Changes in brain function, such as altered connectivity or processing of information.
Learned patterns: Symptoms may sometimes arise as a learned response to pain or other physical sensations.
Medicine Used
There is no single medication specifically for FND. Treatment focuses on managing individual symptoms and addressing underlying factors. Some medications that might be used include:
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) to treat underlying depression or anxiety.
Pain medications: Analgesics for pain management.
Muscle relaxants: For muscle spasms or dystonia.
Medications for comorbid conditions: If the patient has co-existing migraines, sleep disorders, or other conditions, those would be treated accordingly.
It is critical to avoid unnecessary medications that are not indicated for the patient's condition.
Is Communicable
FND is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Precautions depend on the specific symptoms and severity of the FND:
Physical therapy: To improve motor function, balance, and coordination.
Occupational therapy: To help with activities of daily living and adaptive strategies.
Speech therapy: To improve speech and swallowing difficulties.
Psychotherapy: Cognitive behavioral therapy (CBT) or other therapies to address underlying psychological factors, trauma, or anxiety.
Stress management techniques: Relaxation techniques, mindfulness, yoga, etc.
Support groups: Connecting with others who have FND can provide emotional support and practical advice.
Fall prevention: If weakness or balance problems are present, taking precautions to prevent falls, such as using assistive devices or modifying the home environment.
How long does an outbreak last?
The duration of FND symptoms varies greatly. Some individuals may experience symptoms that resolve relatively quickly, while others may have chronic symptoms that persist for months or years. Symptoms can fluctuate in intensity, with periods of remission and exacerbation. The length of an "outbreak" depends on the individual, triggers involved, and effectiveness of the treatment.
How is it diagnosed?
Diagnosis of FND is based on clinical evaluation by a neurologist or other qualified healthcare professional. There is no single test that can definitively diagnose FND. The diagnostic process typically involves:
Medical history: Detailed review of symptoms, medical history, psychological history, and any potential triggers.
Neurological examination: Assessment of motor function, sensory function, reflexes, coordination, and mental status.
Ruling out other conditions: Tests may be performed to exclude other neurological or medical conditions that could be causing the symptoms, such as MRI, CT scans, EEG, blood tests, nerve conduction studies, or lumbar puncture.
Positive signs: The doctor looks for signs that are typically associated with FND, such as inconsistency of the symptoms and certain physical exam findings, such as Hoover's sign.
Diagnostic criteria: Applying established diagnostic criteria, such as those outlined in the DSM-5.
Timeline of Symptoms
The timeline of FND symptoms is highly variable:
Sudden onset: Symptoms can appear suddenly, often following a stressful event, trauma, or physical injury.
Gradual onset: In some cases, symptoms may develop gradually over time.
Fluctuating symptoms: Symptoms may vary in intensity from day to day or even within the same day.
Remissions and exacerbations: Periods of symptom improvement or resolution may be followed by periods of symptom worsening.
Chronic symptoms: Symptoms can persist for months or years.
Important Considerations
FND is a real condition: The symptoms are not "imagined" or "faked".
Diagnosis can be challenging: It can take time to receive an accurate diagnosis due to the complexity of the condition and the need to rule out other causes.
Treatment is multidisciplinary: It often requires a team approach involving neurologists, psychiatrists, psychologists, physical therapists, and other healthcare professionals.
Patient education is crucial: Understanding the condition, its causes, and treatment options is essential for managing FND effectively.
Prognosis varies: Some individuals recover completely, while others experience chronic symptoms. Early diagnosis and treatment can improve the chances of a favorable outcome.
Co-existing conditions: FND often occurs with other mental health conditions such as anxiety, depression, and PTSD.
Stigma: There can be stigma associated with FND because it is often misunderstood. Raising awareness and promoting understanding can help reduce stigma.