Functional Neurological Disorder
Now this is a big condition to be tackling, with a vast amount of names, misconceptions, and misdiagnoses. Functional Neurological Disorder, or FND, presents different symptoms. It is the second most common reason for outpatient neurology visits, after headaches. Single presentation FND is the most common, meaning you have one Functional Symptom. Multi presentation FND is when you have more than two Functional Symptoms. FND may present as seizures, paralysis, dystonia, gait issues, aphasia, stutter, tics, hallucinations, sight loss, hearing difficulty, pain, and more.
The history of Functional Neurological Disorder is not bright; being labeled under psychiatric titles like Conversion Disorder, or Hysteria. This disorder is thought to be part of the cause behind The Dancing Plague of 1518, which could be a whole post by itself (I’m totally writing about that oh my goodness!)!
Neurology is the study of the nervous system, the study of how the brain and body communicate with each other. In many neurological disorders you can see evidence on MRIs, CT scans, or EEGs. FND can be seen on FMRIs, a Functional MRI, which shows where blood flow is going to the brain. This means there is no structural damage or electrical activities causing the symptoms. Rather than the malfunction being in the brain or body, there is a miscommunication in the nervous system. The brain may send a signal for the leg to move, and the body may receive that signal as pain, tremors, or not at all! It’s like a kinked hose, the faucet is working, and the bucket is structurally sound, but somewhere along the line, the water is getting interrupted or disarrayed.
Many neurological movement disorders worsen with stress, and disappear or lessen in sleep. Providers that say that FND is purely a stress disorder are basing their medical opinion on outdated terminology and information. FND is a disorder of the nervous system, which also manages stress. Going back to the kinked hose analogy, lets remember that most disorders and disabilities have both genetic and environmental factors, and say that some hoses are very thin, weak, or pliable, prior to ever experiencing a stressor. For a normal, strong hose, a stressor may dampen the water pressure a bit, or stop the flow for a moment. But with a hose predisposed to bending or leaking? A stressor could cause the hose to spray erratically, or stop flowing at all.
Now, there are many, many conditions that FND can copy or mimic. FND used to be a diagnosis of exclusion, which lead many to feel as if it is a “throw away” and “last resort” diagnosis. However, there are positive testing traits for FND. Multiple doctors should always be visited for diagnosis, as many mental health symptoms can be hormone imbalances, vitamin deficiencies, or physical health issues. A good neurologist will know what to look for!
