Functional Neurological Disorder
Functional Neurological Disorder (FND) is a neurological condition that can cause real and often disabling symptoms involving movement, sensation, vision, thinking, speech, walking, balance, or seizure-like episodes.
FND can look very different from one person to another, and symptoms can change or overlap over time. Importantly, FND is not the same as “nothing being wrong.” The symptoms are real, even when routine testing does not show a structural abnormality.
What Causes FND?
There isn't one single cause of FND.
FND is thought to involve changes in how the nervous system processes and controls information. Symptoms may develop following an injury, illness, pain, migraine, vestibular problem, or other neurological event, or they may develop without an obvious trigger.
Stress, anxiety, trauma, or other psychological factors can play a role for some people, but they are not required for an FND diagnosis. FND is a neurological condition, and symptoms are not consciously produced or imagined.
FND can occur alongside other conditions, including migraine, chronic pain, fatigue, orthostatic intolerance, POTS, concussion, and other neurological disorders.
What Can FND Look Like?
FND can affect many different parts of the nervous system, and symptoms can look very different from one person to another. It's also common for symptoms to overlap.
Some people primarily experience movement symptoms, while others may have sensory, visual, cognitive, gait, speech, or seizure-like symptoms. You may have more than one type of symptom at the same time.
Functional Movement Disorder
Functional movement symptoms can include weakness, tremor, abnormal or involuntary movements, muscle spasms, abnormal posturing, difficulty coordinating movements, or changes in walking and balance.
Functional Seizures
Functional seizures are another type of FND that can cause seizure-like episodes. These episodes can look similar to epileptic seizures, but they are not caused by the abnormal electrical activity associated with epilepsy.
Because functional seizures and epilepsy can occur together, diagnosis and medical management of seizure-like episodes should be handled by a qualified medical provider.
At Clarity Brain and Body Clinic, we do not diagnose or medically manage seizure disorders. We may, however, provide neurological rehabilitation for other conditions that occur alongside functional seizures, such as movement, balance, sensory, visual, cognitive-motor, or autonomic symptoms, when appropriate and with clearance from your medical provider.
Other FND symptoms
FND can also involve:
Sensory symptoms: numbness, tingling, altered sensation, or changes in pain or temperature perception
Visual symptoms: difficulty with eye movements, visual processing, or tolerance of visually complex environments
Cognitive symptoms: brain fog, difficulty concentrating, problems with attention or working memory, or slowed or inconsistent processing
Gait and balance symptoms: difficulty walking, balance problems, or changes in movement while walking
Speech and communication symptoms: changes in speech, voice, or difficulty getting words out
These symptoms don't always fit neatly into one category. Your presentation may include several of these at once.
How is FND diagnosed?
FND is a clinical diagnosis.
That doesn't mean FND is diagnosed simply because an MRI, bloodwork, or other testing is normal. Instead, healthcare providers look for specific positive signs and patterns during the neurological examination that are characteristic of FND.
Depending on your symptoms, an evaluation may include assessment of strength, coordination, sensation, eye movements, balance, gait, attention, and cognitive function.
Additional testing may be appropriate when needed to evaluate other neurological or medical conditions. FND can also occur alongside other conditions, so having another diagnosis does not automatically rule out FND.
If you have not already received an FND diagnosis, evaluation by a neurologist or other qualified clinician may be recommended before beginning FND-specific rehabilitation.
Can FND Get Better?
Yes! Improvement is possible with the right approach.
FND can be frustrating, especially when symptoms are inconsistent, difficult to explain, or have continued despite seeing multiple providers. But having FND does not mean you are stuck with your symptoms forever.
Rehabilitation can help the nervous system build more efficient and reliable patterns of movement, sensation, balance, vision, and cognition. The right approach depends on your particular symptoms, your goals, and the factors that are getting in the way of everyday life.
Progress may not look exactly the same for everyone, but the goal is to help you build back the skills and confidence you need to participate in the things that matter to you.
How can rehabilitation Help?
FND-focused rehabilitation looks at the neurological and functional symptoms that are affecting your ability to move, think, participate, and get through your everyday activities.
Depending on your symptoms and goals, treatment may include:
Movement and coordination retraining
Sensory and balance rehabilitation
Visual and oculomotor rehabilitation
Cognitive-motor training
Gradually increasing the complexity of activities
Practicing skills in situations that resemble everyday life
The goal isn't simply to perform an exercise correctly in the clinic. It's to help those skills carry over into walking, working, exercising, driving, shopping, or whatever else you want to get back to doing.
Treating the whole picture
FND can occur alongside other medical and neurological conditions, and your treatment needs to account for the symptoms that are actually limiting you.
Some patients benefit from care involving several different healthcare professionals. Depending on your symptoms and needs, this may include neurologists, physical therapists, occupational therapists, psychologists or other mental health clinicians, speech-language pathologists, or other members of your healthcare team.
At Clarity Brain and Body Clinic, our focus is on the neurological and functional aspects of your symptoms through individualized rehabilitation. When another type of care is needed, collaboration with or referral to the appropriate provider may be part of your treatment.
Why Choose Clarity Brain and Body Clinic?
FND can be frustrating, especially when symptoms are difficult to explain or seem to change from day to day. At Clarity Brain and Body Clinic, we focus on understanding how your nervous system is functioning and building an individualized rehabilitation plan around the symptoms that are affecting your daily life.
Progress is possible with the right approach.
Schedule your free discovery call with Dr. Timko today to learn how neurological rehabilitation can help you improve function and get back to doing more of the things you love.