Examples of communication for functional neurological disorder based on clinical features and neuroscience of the disorder
| FND problem | Examples |
|---|---|
| Rule in diagnosis | ‘You have FND for the following reasons: a, b and c.’ |
| General | ‘FND is a problem with the functioning of the nervous system. A problem with the software rather than the hardware.’ Or, for patients that aren't as computer literate: ‘It's like a piano that is out of tune, not broken but just not working properly.’ |
| Overcoming dualism | Patient: ‘So, are you saying it's in my mind or brain?’ |
| Healthcare professional: ‘FND is a condition that shows that the mind and the brain are one and the same thing.’ | |
| Limb weakness | ‘Did you see how your leg returned briefly to normal when I did that test (Hoover's sign). That shows us that there is a problem with the way your brain is sending the signal to your leg (voluntary movement), but the automatic movements are still okay.’ |
| Limb weakness/blindness | ‘Have you heard of phantom limb syndrome? That's when someone has an amputation, but their brain still thinks the limb is there. FND is a bit like the opposite, the leg/vision/sensation is there but the brain thinks it isn't anymore. The map of that part of the body in the brain has gone wrong’ |
| Weakness/movements | ‘Functional brain scans have shown that the brain is working too hard in FND. Normally we shouldn't have to think about how to move our arms our legs. As soon as our brains start to work on this too hard it goes wrong. It's similar to thinking about your feet when you are climbing upstairs, or trying too hard to fall asleep at night.’ |
| Seizures | ‘Functional seizures are when the brain goes into a trance-like state called “dissociation” suddenly, all by itself. This is the medical word for being cut off or distant from your surroundings. That's a bit like the feeling you have just before your seizures sometimes. We think it does this as a “reflex” response – sometimes to get rid of a horrible feeling that many people report just before. After a while, it will often happen for no reason and when people are most relaxed.’ |
| Dystonia | ‘Your brain thinks that the foot is straight even though it's turned inwards. That's why it's hard for you to keep it in a straight position.’ |
| Associated pain | ‘Chronic pain is usually due to an “increased volume knob” in the pain pathways throughout the nervous system, but especially the brain. This is called ‘central sensitisation’ and, like FND, is also a problem with abnormal nervous system functioning.’ |
| Prognosis | ‘This is not an easy problem to put right, but it does have the potential to improve and many people do make a good recovery.’ |
| Physiotherapya | ‘Physiotherapy can help “retrain” the brain in FND. It works best when we can use those principles of distraction that I showed you. A physiotherapist may ask you to try to speed up the movement or do it in an unusual way, to music or in a mirror. Somewhere in your brain we think the automatic movements are in there, and we need to coax them out.’ |
| Psychiatry/psychologya | ‘It's common in FND for people to have problems like anxiety and depression. This can be a consequence of having the symptoms but, in many, it is already there for other reasons. FND symptoms make people fearful of falling and being injured and of being embarrassed. For some, there are things that have happened which may explain why your brain is vulnerable to going wrong in this way and could be worth exploring. I think a psychiatric/psychological assessment could be helpful. What do you think?’ |
↵a = occupational therapy and speech and language therapy also may be important; FND = functional neurological disorder.