Functional neurological disorders: symptoms, causes and treatment

Functional neurological disorders are one of the most enigmatic disorders of the brain. Its cause is not very well known, because they have neurological symptoms but the brain seems to be fine. Despite this, the patient's symptoms are totally real and cause a discomfort that, of course, is also very real.

Although not much is known about these disorders, they are believed to be the second leading cause of consultation in neurology, making them very common but, ironically, remain very little known in the general public and those who suffer from them often suffer the symptoms in loneliness and incomprehension.

Here let's talk about what are functional neurological disorders, its main symptoms, what are the causes that have been considered as possible and, also, help to make a disorder a little visible whose awareness is still low.

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What are functional neurological disorders?

The term "functional neurological disorders" is a relatively recent and broad term used to describe the

conditions in which neurological symptoms occur but cannot be explained due to a disease of the nervous system or other organic problems. These have received multiple names throughout history: hysterical neurosis, conversion disorders, psychosomatic, psychogenic, medically unexplained disorders ...

Normally, these disorders affect movement and the senses, impairing the ability to walk, swallow, see or hear. The severity of the symptoms can vary greatly from patient to patient, and its duration is also highly variable.

The patient has no control over these symptoms and does not intentionally produce them. Although the cause of it is not known, the symptoms suffered by the patient are very real and cause a lot of discomfort, in addition to interfering in his daily life.

Functional neurological disorders can be triggered by a neurological disorder or, also, by a reaction stress, physical trauma, or the experience of a psychologically traumatic situation, although it is not always So. These disorders are related to the way the brain works, not damage to brain structure, as it would occur in a stroke, multiple sclerosis, a head injury or a brain infection.

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Symptoms

As we mentioned, the symptoms and signs of functional neurological disorders vary greatly depending on the case, but what they have in common is that they are serious enough to cause a deterioration in the patient's quality of life, emotional distress and require a medical evaluation. The symptoms associated with these problems can affect the movement and functioning of the body, in addition to altering the senses.

Among the signs and symptoms that affect the functioning and movement of the body we find:

• Weakness or paralysis
• Tremors
• Trouble walking
• Loss of balance
• Difficulty to swallow
• Pharyngeal globe (feeling of a lump in the throat)
• Seizures or episodes of tremors and an apparent loss of consciousness
• Episodes of lack of reaction

And among the signs and symptoms in which the senses are affected we have:

• Numbness of the limbs
• Feeling of loss of sensitivity to touch
• Speech problems: stammering or inability to speak
• Vision problems: double vision or blindness
• Hearing problems: hearing worse or deafness

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Causes

As we have advanced, the exact cause behind functional neurological disorders is an enigma. There are several hypotheses and theories about what happens at the brain level for the symptoms associated with this type of disorder to occur, some very complex explanations that cover several mechanisms that may be different depending on the type of functional neurological disorder of each patient.

Symptoms of functional neurological disorders can appear suddenly after a very stressful episode. Too They can manifest after receiving physical trauma or having been through an emotionally very difficult situation.

In addition, it has been hypothesized about the influence of triggers that induce changes or alterations in the functioning of the brain at the structural, cellular or metabolic level. Despite all these proposals as possible causes behind functional neurological disorders, it is not always possible to identify the trigger for the symptoms.

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Risk factor's

The fact that it is not known with certainty what are the causes behind functional neurological disorders has not been an impediment to identify which are the risk factors that increase the chances of suffering from one of them. Among the factors that can increase the risk of presenting this type of disorders we find:

• Having a neurological disease or disorder (eg. eg, migraines, epilepsy ...)
• Physical trauma, emotional trauma, or significant great stress
• Having a mental disorder: anxiety disorder, personality disorders ...
• Family history of functional neurological disorder
• History of childhood sexual and / or physical abuse or neglect
• To be a woman

Diagnosis

As of today, there are not many standard tests for the diagnosis of functional neurological disorders. Generally, the diagnosis is made by evaluating the symptoms that the patient indicates to suffer, ruling out any neurological disease or other condition that could cause them.

Functional neurological disorders are diagnosed by evaluating which symptoms are present and which ones are absent. That is, it is looked at if certain specific patterns of signs and symptoms typical of a neurological disorder are present but it is also evaluated if no structural alterations are shown by neuroimaging techniques such as magnetic resonance imaging (MRI) or abnormalities in a electroencephalogram.

As there is an apparent neurological alteration, during the diagnosis of this type of disorders it is necessary to participation of a neurologist, but may also include the collaboration of a psychiatrist and a psychologist clinical. The doctor can use several terms to describe the same situation: functional neurological disorders, functional neurological symptom disorder, or hysterical neurosis (the latter currently in disuse).

Typically, the term "functional neurological disorders" is preferred because it can be used to specify the type of functional neurological symptom that the patient suffers from. For example, if the patient manifests walking problems, the doctor will name it as a case of functional gait disorder, or if there are problems swallowing, you may call it functional disorder of the gait. swallowing.

The evaluation process comprises the following.

1. Physical exploration

The doctor examines the patient and asks questions about her health and what signs or symptoms have been bothering her in recent weeks. In this phase tests are applied to rule out other medical conditions that could explain the symptoms for which the patient has consulted. The type of test that is applied will depend on what signs and symptoms the affected person manifests.

2. Psychiatric examination

In the event of psychological problems, the neurologist may refer the patient to a mental health professional, both a psychiatrist and a clinical psychologist. The professional will ask the patient questions about her feelings, thoughts and behavior, identifying and analyzing the psychological symptoms that could be related to a supposed case of neurological disorder functional.

The professional will make the diagnosis based on the clinical criteria of the DSM-5. In this manual, functional neurological disorders are referred to as conversion disorder and also referred to as functional neurological symptom disorder. Its diagnostic criteria are as follows:

• One or more symptoms of alteration of voluntary motor or sensory function.
• Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
• The symptom or deficiency is not better explained by another medical or mental disorder.
• The symptom causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The DSM-5 itself indicates that it is necessary to specify the type of main symptom that affects the patient:

• With weakness or paralysis
• With abnormal movement (p. g., tremor, dystonic movement, myoclonus, gait disorder)
• With swallowing symptoms
• With speech symptom (p. g., dysphonia, poor articulation)
• With fits or seizures
• With anesthesia or sensory loss
• With special sensitive symptom (p. g., visual, olfactory or hearing impairment)
• With mixed symptoms

Specify if:

• Acute episode: Symptoms present for less than six months.
• Persistent: Symptoms for six months or more.

Specify if:

• With psychological stressor (specify stressor)
• No psychological stressor

Treatment

Treatment will depend on the type of functional neurological disorder, symptoms and signs that the patient presents. Either way, the most useful thing for this type of disorder is that the treatment is carried out by a multidisciplinary team of professionals, formed by neurologists, psychiatrists and psychologists, as well as speech therapists, physiotherapists and occupational therapists depending on what the particular case of the patient requires.

It is essential to educate the patient, explaining to him and making sure that he understands what functional neurological disorders are. The professional who treats you must show him that he understands that his symptoms are real, that they are not an invention or an exaggeration, but that the organic cause is not so clear.

Sometimes symptoms may improve after giving the patient an extensive explanation of their disorder, giving understand that you do not have a serious medical problem in which your life is at risk, despite having symptoms upset.

Too it is important to involve the family, making you understand that your loved one's symptoms are real, and that they should be supportive and understand that it is not a pretense to attract attention or complain about nothing.

We found several therapies used in the treatment of neurological disorders, each one used according to the needs of the particular case:

1. Occupational therapy

Occupational therapy can improve symptoms associated with movement and prevent possible complications.. By regularly moving arms and legs, muscle stiffness and weakness that can occur in cases of paralysis or loss of mobility is avoided. The gradual increase in exercise provides greater autonomy to the patient.

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2. Speech therapy and the orophone apparatus

With the help of a speech therapist can be addressed symptoms including trouble speaking or swallowing.

3. Stress reduction and distraction techniques

Various techniques can be used aimed at reducing the patient's stress. Among these techniques we find the progressive muscle relaxation, breathing exercises and physical exercise.

On the other hand, distraction techniques can also serve to improve the patient's quality of life, ceasing to pay attention to your bothersome somatic symptoms and occupying your mind with other tasks. This can be done by listening to music, talking to other people, or by intentionally changing the way you walk and move.

4. Cognitive behavioral therapy

In order to manage the psychological problems associated with functional neurological disorder, cognitive-behavioral psychotherapy can be used. Through this therapy modality awareness of inaccurate or negative thoughts that may have had a detrimental influence in certain situations that the patient has had to face.

Cognitive behavioral therapy is used to treat other mental health disorders that may have aggravated the symptoms of the neurological disorder. Among them, we would find anxiety, depression, personality disorders, bipolar disorder ...

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5. Pharmacology

Medications are not considered effective in treating functional neurological disorders. In fact, the US Food and Drug Administration (FDA) does not approve any drugs specifically as a treatment for these neurological conditions.

Nevertheless, Antidepressants are thought to be helpful in the event of depression or a mood disorder influencing the severity of the disorder.

Visibility of these disorders

Although it is considered to be the second cause of consultation in neurology services, functional neurological disorders have little recognition public level, both in medical circles and among the general population, which means that on many occasions these disorders are suffered from loneliness and incomprehension.

That their cause is not clear does not mean that they are not real, and in fact those who suffer from them can have a disability and a deterioration in the quality of life similar to that caused by diseases such as Parkinson's disease or epilepsy.

Since 2012, the International Day of Functional Neurological Disorders has been celebrated on April 13, a celebration that aims to support people affected by these disorders and raise awareness in society about their existence. This is to combat the stigma that patients with functional neurological disorders often suffer, because the belief is still very widespread that if there is no organic cause that explains it, the symptoms are simulation.