Functional neurological disorders

Overview

Functional neurological disorders (FND) have a long and rich history, spanning many centuries, from ancient Greece to Jean-Martin Charcot in the Salpêtrière to Sigmund Freud's transforming psychoanalytic theories.

Diagnosis of FND is made when clinical findings of neurological symptoms are found to be incompatible with recognized neurological or medical conditions (DSM-V). For example, for psychogenic nonepileptic seizures, the gold standard diagnosis is made with video EEG demonstrating a typical spell in the absence of epileptiform activity.

Treatment considerations include:

- Psychopharmacologic trials have not proven successful treating FND in clinical trials. Patients may benefit, however, from psychopharmacologic intervention for other comorbid diagnoses (anxiety or affective disorders, for example)

- The main treatment for FND is psychotherapy and/or rehabilitation with PT, OT, and/or SLP depending on the specific area of dysfunction. (i.e. physical therapy for functional gait disorders, cognitive rehabilitation therapy for functional cognitive disorders, or speech and language therapy for functional speech disorders)

Syndrome specific FND

Psychogenic nonepileptic seizures

Functional cognitive disorder (cogniform disorder)

Functional tremor

Persistent postural-perceptual dizziness

Helpful educational websites

https://www.nonepilepticseizures.com/

https://fndhope.org/

http://neurosymptoms.org/

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). (American Psychiatric Association).