Functional Neurological Disorder

Name given for symptoms in the body which appear to be caused by problems in the nervous system but which are not caused by a physical neurological disease or disorder

Aetiology

  • Higher percentages of this disorder in people with irritable bowel syndrome, chronic pain patients, patients with PTSD, patients with antisocial personality disorder

Pathophysiology

  • Not consciously mediated
  • Patient has no control of the attacks
  • Related to:
    • Traumatic events
    • Physical/sexual abuse
    • Other stress
    • Anxiety or depression

Clinical presentation

  • Sensory symptoms - positive (e.g. pain) or negative (e.g. anaethesia)
  • Concentration, memory and fatigue problems
  • Movement symptoms e.g. difficulty moving, extra involuntary movements
  • Functional seizures
    • Attacks with prominent motor activity
    • Episodes of collapse with no movement
    • Abreactive attacks - fear, gasping, hyperventilation
    • Duration often prolonged e.g. 10-20 mins

Investigations

  • History
  • Linguistic analysis
  • Ruling out of physical causes e.g. EEG to rule out epilepsy

Management

  • Education and support
  • Appropriate counseling for any previous traumatic events
  • Treatment of any associated anxiety or depression
  • CBT standard treatment of choice