Summary about Disease
Functional gait disorder (FGD) is a condition characterized by an abnormal walking pattern that is not caused by an underlying neurological or orthopedic disease. It's considered a type of functional neurological disorder (FND), where neurological symptoms occur without identifiable structural brain damage or disease. The gait abnormalities are thought to arise from altered brain function, particularly related to motor control and movement programming. The symptoms are real and can be significantly disabling, despite the lack of a clear organic cause.
Symptoms
The symptoms of FGD involve various abnormalities in gait and balance. Common features include:
Unusual or exaggerated gait patterns: These can vary widely, including shuffling, jerky movements, wide-based stance, staggering, and inconsistent walking speed.
Sudden buckling or giving way: The legs may unexpectedly collapse, leading to falls.
Dragging of the feet: One or both feet may drag along the ground during walking.
Tremor: Tremulous movements in the legs or trunk that worsen with walking.
Balance problems: Difficulty maintaining balance, leading to swaying or unsteadiness.
Slowed walking speed: Overall reduction in walking pace.
Circumduction: Swinging the leg out to the side to clear the ground.
Astasia-abasia: Inability to stand or walk despite having normal strength and coordination when lying down.
Causes
The exact cause of FGD is not fully understood. It's believed to be related to a complex interplay of factors, including:
Psychological factors: Stress, anxiety, depression, trauma, and other mental health conditions can contribute to the development of FGD.
Neurological vulnerabilities: Some individuals may have a predisposition to developing functional neurological symptoms.
Learned patterns: The gait abnormality may initially develop in response to a minor injury or illness and then become a learned motor pattern.
Altered brain function: Research suggests that FGD may involve changes in the way the brain processes and controls movement. There is no identifiable structural brain damage.
Triggers: The onset of symptoms can sometimes be linked to a physical injury, illness, or stressful life event.
Medicine Used
There is no specific medication to directly treat functional gait disorder. Treatment focuses on managing the underlying psychological and neurological factors contributing to the symptoms. Medications may be used to address comorbid conditions such as:
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be prescribed if depression or anxiety is present.
Anti-anxiety medications: Medications like benzodiazepines (use with caution due to risk of dependence) or other anti-anxiety drugs may be used to manage anxiety symptoms.
Pain medications: If pain is a contributing factor, analgesics or neuropathic pain medications may be considered.
Other medications: In some cases, medications used to treat other neurological conditions may be trialed, but these are not typically the primary treatment approach. The focus is typically on physical and occupational therapy and psychotherapy.
Is Communicable
Functional gait disorder is not communicable. It is not caused by an infectious agent and cannot be transmitted from person to person.
Precautions
Precautions for individuals with FGD focus on managing symptoms and preventing falls:
Physical therapy: Following the prescribed exercise program to improve strength, balance, and coordination.
Assistive devices: Using a cane, walker, or other assistive devices as needed to maintain balance and stability.
Home safety: Modifying the home environment to reduce fall risks, such as removing tripping hazards, installing grab bars in bathrooms, and improving lighting.
Psychological support: Seeking therapy to address underlying psychological factors contributing to the condition.
Stress management: Practicing relaxation techniques and engaging in activities that reduce stress.
Medication adherence: Taking prescribed medications as directed to manage comorbid conditions.
Regular medical follow-up: Attending regular appointments with healthcare providers to monitor symptoms and adjust the treatment plan as needed.
How long does an outbreak last?
FGD is not an outbreak. This condition can have varying durations, ranging from weeks to months or even years. The course of FGD can be unpredictable, with periods of improvement and worsening of symptoms. Some individuals may experience a complete resolution of symptoms, while others may have persistent symptoms that require ongoing management. The duration is highly individual and depends on factors such as the severity of symptoms, the presence of comorbid conditions, and the effectiveness of treatment.
How is it diagnosed?
Diagnosis of FGD is typically made by a neurologist or other healthcare professional experienced in functional neurological disorders. The diagnostic process involves:
Detailed medical history: Gathering information about the patient's symptoms, medical history, psychological history, and any potential triggers.
Neurological examination: Assessing motor function, sensory function, reflexes, and coordination to rule out other neurological conditions.
Observation of gait: Carefully observing the patient's walking pattern to identify characteristic features of FGD.
Exclusion of other conditions: Performing tests, such as MRI scans, blood tests, and nerve conduction studies, to rule out underlying neurological or orthopedic diseases.
Diagnostic criteria: Using established diagnostic criteria for functional neurological disorders to determine if the patient meets the criteria for FGD.
Positive findings: Emphasis is placed on identifying positive signs of functional disorder during the physical exam, rather than solely relying on the absence of findings from other neurological diseases.
Psychiatric Assessment: Assessment by mental health professionals can assist in diagnosing any co-morbid psychiatric conditions, and in understanding how these may be impacting on the condition
Timeline of Symptoms
The timeline of symptoms in FGD can vary considerably:
Onset: Symptoms can appear suddenly or gradually. In some cases, there may be a clear trigger, such as a physical injury or stressful event. In other cases, the onset may be more insidious.
Progression: The symptoms may initially be mild and then gradually worsen over time. In other instances, the symptoms may be severe from the onset.
Fluctuations: The severity of symptoms can fluctuate from day to day or even within the same day. There may be periods of improvement and periods of worsening.
Persistence: Some individuals may experience a complete resolution of symptoms within a few weeks or months. Others may have persistent symptoms that last for years.
Relapses: Relapses, where symptoms return after a period of improvement, can occur.
Important Considerations
Legitimacy of symptoms: It is crucial to recognize that the symptoms of FGD are real and are not consciously produced or feigned. The patient is not "faking" or "making up" their symptoms.
Multidisciplinary approach: Treatment for FGD is best provided by a multidisciplinary team that includes neurologists, psychiatrists, physical therapists, and occupational therapists.
Patient education: Educating the patient about FGD, its causes, and treatment options is essential for promoting understanding and adherence to treatment.
Psychological support: Providing psychological support to address underlying psychological factors and improve coping skills is critical.
Realistic expectations: It is important to have realistic expectations about the course of FGD and the potential for improvement.
Avoidance of unnecessary investigations: Minimizing unnecessary medical investigations and treatments can help prevent iatrogenic harm and reduce healthcare costs.
Focus on rehabilitation: Rehabilitation strategies, such as physical therapy and occupational therapy, can help improve function and quality of life.
Comorbid conditions: Recognize and treat any co-existing conditions like depression or anxiety to assist in the management of functional gait disorders.