Functional neurological disorder (FND)

Functional neurological disorder (FND) | NHS inform | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Functional neurological disorder Functional neurological disorder Functional neurological disorder (FND) describes a problem with how the brain receives and sends information to the rest of the body. Its often helpful to think of your brain as a computer. In someone who has FND, theres no damage to the hardware, or structure, of the brain. Its the software, or program running on the computer, that isnt working properly. The problems that cause FND are going on in a level of the brain that you cannot control. It includes symptoms like arm and leg weakness and seizures. Other symptoms like fatigue or pain are not directly caused by FND, but are often found alongside it. Symptoms of FND FND can have many symptoms that can vary from person to person. Some people may have few symptoms, and some people may have many. A diagnosis of FND should be made because you have one or more clinical features that a specialist can recognise as typical of FND. It shouldnt be made just because scans or tests for other neurological conditions that have similar symptoms are normal. What is a clinical feature? A clinical feature is a distinctive way that your symptom presents that is unique to FND. For example, it could be that your eyes close during seizures, or that limb weakness briefly disappears during certain physical tests. Clinical features are what specialists use to identify FND from other neurological conditions with similar symptoms. Functional limb weakness Functional limb weakness is when a leg or an arm doesnt work properly. In FND, this happens because of a problem with how the nervous system is functioning. It can cause a range of symptoms, including: problems walking heaviness down one side dropping things feeling like a limb isnt part of you Functional limb weakness can often look a symptoms of a stroke or multiple sclerosis. If you have FND, any scans you have will show no damage to the brain to explain the weakness. A specialist will diagnose functional limb weakness based on specific clinical features (symptoms) they find when they examine you. Read more about functional limb weakness Functional seizures A functional seizure (also called a dissociative seizure) is an episode where someone loses either their awareness of, or their ability to interact with, their surroundings. It may look like an epileptic seizure or a faint. A functional seizure can appear as: uncontrolled shaking suddenly going motionless and unresponsive staring without responding to surroundings Some people are aware that seizures are about to happen, while others experience them without warning. A specialist will ask you and your friends or family about what happens during a seizure, and will look at any video footage you can provide. Theyll use this evidence to decide if its epilepsy , a faint or a functional seizure. Read more about functional seizures Functional tremor Tremor is uncontrollable shaking of part of the body. Its most often found in the arms and legs. Functional tremor can come and go throughout the day, and change in speed and strength. A specialist will diagnose functional tremor based on specific features of your symptoms that they find when they examine you. Read more about functional tremor Functional dystonia Functional dystonia is a type of muscle spasm. It causes a part of the body to become stuck in an unusual position. This can be for a short or a long period of time. Someone with functional dystonia will often present with curled fingers, a clenched hand, or an ankle that turns in. Read more about functional dystonia Functional gait disorder Functional gait disorder describes the problems walking that you may experience as part of FND. You may find you have a dragging leg, that you feel unsteady when walking, or that you make excessive movements when walking. A specialist will diagnose functional gait disorder based on clinical features, like the way your walking changes when doing different activities. Read more about functional gait disorder Functional facial spasm Functional facial spasm is when there are muscle spasms in the face. These can lead to problems like a narrowing of the eye or the pulling of the mouth or jaw upwards, downwards or to the side. Read more about functional facial spasm Functional tics A tic is a fast repetitive movement or sound that happens suddenly. Functional tics can be a symptom of FND. Functional tics can look similar to the tics in Tourettes syndrome. A specialist will look at the clinical features of your tics to make a diagnosis. Its quite common to have both functional tics and Tourettes syndrome. Functional jerks and twitches A symptom of FND can be jerks or twitches, which is when someone makes sudden movements. Everyone experiences random jerks occasionally, like when you jolt awake as youre falling asleep. In FND, however, these uncontrolled jerks and twitches can become much more frequent. Read more about functional jerks and twitches Functional drop attacks Functional drop attacks are when someone falls to the ground suddenly, without losing consciousness. Read more about functional drop attacks Functional sensory symptoms A symptom of FND can be numbness, pins and needles, or a feeling that a limb isnt part of your body. Read more about functional sensory symptoms Functional cognitive symptoms Problems with your memory or concentration can be a symptom of FND. You might find that you: lose track while doing things, for example being unable to remember why you went into a room go blank, for example when trying to recall your pin number lose track during conversations misplace important things, like your keys or phone forget words Its normal to experience these things occasionally. For someone with functional cognitive symptoms, these things happen so often that they interfere with work and home life. The cognitive symptoms of FND can sometimes be mistaken for dementia. Specialists will look for features that are typical of functional cognitive symptoms when diagnosing FND. Read more about functional cognitive symptoms Functional speech and swallowing difficulties Functional speech and swallowing difficulties can be a symptom of FND. You might experience: slurred speech a new stutter difficulties finding the right word unintentionally mixing words up whispering or hoarse speech (dysphonia) difficulty swallowing, including feeling like theres something stuck in your throat A specialist will diagnose functional speech and swallowing difficulties based on specific features. Read more about functional speech and swallowing difficulties Persistent postural perceptual dizziness (PPPD) PPPD (sometimes called functional dizziness, triple PD or 3PD) can be a symptom of FND. The dizziness in PPPD is typically experienced constantly, and gets worse while walking or in crowded environments. There are many causes of dizziness. Most people with PPPD have another cause of dizziness at the same time. A specialist will diagnose PPPD based on specific features when they assess you. Read more about PPPD Functional visual symptoms Visual symptoms can be a part of FND. You may experience changes to your vision, like: blurred vision double vision photophobia (sensitivity to light) reduced vision A specialist will diagnose functional visual symptoms based on specific features that they find when they examine you. Read more about functional visual symptoms Dissociative symptoms Dissociative symptoms are common in FND, although there are many other causes. These symptoms can be hard to describe, but are often described as feeling: that your body is disconnected from you that your body doesnt belong to you disconnected from the world around you spaced out that you are floating that you are having an out-of-body experience there but not there You may also be able to hear whats going on around you, but not be able to respond. These experiences are called dissociation, and can link into other FND symptoms. Read more about dissociative symptoms There are other symptoms or conditions that are commonly associated with FND. These include: chronic pain , including fibromyalgia , back and neck pain, and complex regional pain syndrome persistent fatigue sleep problems including insomnia (not sleeping enough) and hypersomnia (sleeping too much) migraines and other types of headache and facial pain irritable bowel syndrome and other problems with the function of your stomach and bowel anxiety and panic attacks depression post-traumatic stress disorder chronic urinary retention despite all tests being normal (which may be diagnosed as Fowlers syndrome) dysfunctional breathing What causes FND? We know that the symptoms of FND happen because theres a problem with how the brain is sending and receiving messages to itself and other parts of the body. Using research tools, scientists can see that certain circuits in the brain are not working properly in people with FND. However, theres still a lot of research to be done to understand how and why FND happens. Why does FND happen? FND can happen for a wide range of reasons. Theres often more than one reason, and the reasons can vary hugely from person to person. Some of the reasons why the brain stops working properly in FND include: the brain trying to get rid of a painful sensation a migraine or other neurological symptom the brain shutting down a part or all of the body in response to a situation it thinks is threatening In some people, stressful events in the past or present can be relevant to FND. In others, stress is not relevant. The risk of developing FND increases if you have another neurological condition. Read more about how and why FND happens. Diagnosing FND When diagnosing FND, your healthcare provider will carry out an assessment to see if there are typical clinical features of FND. Your healthcare provider may still choose to test for other diseases and conditions before diagnosing FND. This is because many conditions share the same symptoms and, in around a quarter of cases, FND is present alongside another neurological condition. Someone can have both FND and conditions like sciatica, carpal tunnel syndrome, epilepsy, or multiple sclerosis (MS). The diagnosis of FND, however, should be given because you have the clinical features of FND. It shouldnt be given just because theres no evidence of other conditions or illnesses. Because the symptoms of FND are not always there, your healthcare provider may ask you to video your symptoms. This will allow them to see what your symptoms look like. Treatments FND is a really variable condition. Some people have quite short-lived symptoms. Others can have them for many years. There are treatments available that can manage and improve FND. These treatments are all forms of rehabilitation therapy, which aims to improve your ability to carry out every day activities. Many of these treatments are designed to retrain the brain. Some people with FND benefit a lot from treatment and may go into remission. Other people continue to have FND symptoms despite treatment. Physiotherapy Specialised physiotherapy can be useful in treating FND. It helps to remind the body how it should move. It can also help you build up strength and stamina you may have lost. Read more about physiotherapy for FND Occupational therapy Occupational therapy can be helpful in treating FND. An occupational therapist will work with you to plan your treatment goals, and gradually build your confidence and ability to reach them. Read more about occupational therapy for FND Psychological therapy Psychological therapy can be helpful to many people with FND, even those without stress in their lives. It can help you gain a better understanding of FND and its relationship to your personal circumstances. There are specific psychological techniques which can help you gain better control over movement or seizure symptoms. Psychological therapy can also help you learn to manage low mood, anxiety and past traumatic events, as well as other psychological problems (if present). Not everyone with FND will need psychological therapy. Read more about psychological therapy for FND Speech, language and swallowing therapy Speech and language therapists are available to help if youre struggling with speaking or swallowing. They have a range of techniques to try, designed to help with specific problems. These might include helping you to shape certain sounds, or to practice breathing patterns as you try to talk. Read more about speech and language therapy for FND Medication Medication can play a role in treating the some of the problems associated with FND, like pain, depression and anxiety. Your healthcare provider can help decide if medication is right for you. There are many types of medication that can make FND worse, including opiates like morphine, dihydrocodeine or codeine. It may be worth discussing your current medications with your healthcare provider. Do not stop taking any medicine thats been prescribed without checking with your GP or healthcare provider first. You could make yourself very ill. Read more about treating FND FND in children and young people FND is broadly the same condition in children and young people. Its unusual for it to occur under the age of 10. It becomes more common through the teenage years. The treatment for FND in children and young people is similar to adults. Its especially important for families and schools to learn about the condition, so they can respond in the most helpful way. Where to find support If youve been diagnosed with FND there are sources of information, charities and support groups that can help you. The Neurosymptoms FND Guide has more detailed information. Theres also an app available with further details about the condition. My FND is an app that allows you to learn about your symptoms. It helps you track them, and offers advice for managing them. FND Hope UK is a charity that raises awareness of FND. It provides further information, resources, and support services for those with FND. FND Action is a charity that provides information on FND and support for those with a diagnosis. Source:\r\n                                        Scottish Government - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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