Functional neurological disorders: symptoms, causes and treatment

What are functional neurological disorders? Let's take a look at their characteristics and treatment.

Functional neurological disorders are one of the most enigmatic disorders of the brain. Their cause is not very well known, because they have a neurological symptomatology but the brain seems to be fine. Despite this, the patient's symptoms are totally real and produce 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 conditions but ironically they remain largely unknown in the general public and sufferers often suffer the symptoms in loneliness and incomprehension.

Here we will discuss what functional neurological disorders are.The main symptoms, what are the causes that have been considered as possible and, also, to help to make a little visible a disorder whose awareness is still scarce.

What are functional neurological disorders?

The term "functional neurological disorders" is a relatively recent and broad term used to describe conditions in which neurological symptoms are present. conditions in which neurological symptoms are present but cannot be explained by a disease of the nervous system or other organic problem.. These have received multiple names throughout history: hysterical neurosis, conversive disorders, psychosomatic, psychogenic, medically unexplained disorders....

Normally, these disorders affect the movements and senses, altering the ability to walk, swallow, see or hear. The severity of the symptomatology 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 is unknown, the symptoms experienced by the patient are very real and cause a great deal of discomfort and interfere with the patient's daily life.

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

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 deterioration in the patient's quality of life, emotional discomfort and require medical evaluation. The symptoms associated with these problems can affect the movement and functioning of the body, as well as altering the senses..

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

• Weakness or paralysis
• Tremors
• Problems walking
• Loss of balance
• Difficulty swallowing
• Balloon pharyngeal (lump in the throat sensation)
• Seizures or episodes of tremors and an apparent loss of consciousness
• Episodes of unresponsiveness

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

• Numbness of the extremities
• Sensation of loss of sensitivity to touch
• Speech problems: stammering or inability to speak.
• Vision problems: double vision or blindness
• Hearing problems: poorer hearing or deafness

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 to cause the symptoms associated with this type of disorders, very complex explanations that include several mechanisms that may be different depending on the type of functional neurological disorder of each patient.

Symptoms of functional neurological disorders may appear suddenly after a very stressful event. Also may also manifest after receiving physical trauma or having gone through a very hard emotional situation..

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

• You may be interested in, "What is trauma and how does it influence our lives?"

Risk factors

The fact that the causes behind functional neurological disorders are not known with certainty has not prevented us from identifying the risk factors that increase the likelihood of suffering from one of them.. Among the factors that can increase the risk of presenting this type of disorders we find:

• Neurological disease or disorder (e.g., migraines, epilepsy...)
• Physical trauma, emotional trauma or major significant stress
• Suffering from a mental disorder: anxiety disorder, personality disorders...
• Family history of functional neurological disorder
• History of neglect or sexual and/or physical abuse in childhood
• Being a woman

Diagnosis

To date, 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 have, ruling out any neurological disease or other condition that could cause them..

Functional neurological disorders are diagnosed by assessing which symptoms are present and which are absent. In other words, we look to see if certain specific patterns of signs and symptoms characteristic of a neurological disorder are present, but we also assess whether no structural alterations are shown by means of neuroimaging techniques such as magnetic resonance imaging (MRI) or abnormalities in an electroencephalogram.

Since there is apparent neurological disturbance, the diagnosis of this type of disorder requires the participation of a neurologist, but may also include the collaboration of a psychiatrist and a clinical psychologist. The physician may use several terms to describe the same situation: functional neurological disorders, functional neurological symptom disorder or hysterical neurosis (the latter is no longer used). (the latter currently in disuse).

The term "functional neurological disorders" is usually preferred because it can be used to specify the type of functional neurological symptom from which the patient suffers. For example, if the patient manifests problems with walking, the physician will name it as a case of functional gait disorder, or if there are problems with swallowing, he/she may call it a functional swallowing disorder.

The evaluation process involves the following.

1. Physical examination

The physician examines the patient and asks questions about the patient's health and what signs or symptoms have bothered the patient in recent weeks. At this stage, tests are applied to rule out other medical conditions that could explain the symptoms. that could explain the symptoms for which the patient has come for consultation. The type of test applied will depend on the signs and symptoms manifested by the patient.

2. Psychiatric examination

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

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

• One or more symptoms of impaired voluntary motor or sensory function.
• Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
• The symptom or impairment 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 affecting the patient:

• With weakness or paralysis
• With abnormal movement (e.g., tremor, dystonic movement, myoclonus, gait disorder)
• With swallowing symptoms
• With speech symptom (e.g., dysphonia, slurred articulation)
• With seizures or convulsions
• With anesthesia or sensory loss
• With special sensory symptom (e.g., visual, olfactory or auditory disturbance)
• 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).
• Without psychological stressor

Treatment

Treatment will depend on the type of functional neurological disorder, symptoms and signs presented by the patient. Be that as it may, the most useful for this type of disorders is that the treatment is carried out by a multidisciplinary team of professionals, made up of neurologists, psychiatrists and psychologists, as well as speech therapists, physiotherapists andThe treatment should be carried out by a multidisciplinary team of professionals, made up of neurologists, psychiatrists and psychologists, as well as speech therapists, physiotherapists and occupational therapists, depending on what the patient's particular case requires.

It is essential to educate the patient, explaining and ensuring that he/she understands what functional neurological disorders are. The attending professional must show the patient that he/she understands that his/her symptoms are real, that they are not an invention or an exaggeration, but that the organic cause is not so clear.

Sometimes, the symptoms may improve after giving the patient an extensive explanation of his disorder, giving him to understand that he does not have a serious medical problem in which his life is at risk, in spite of having bothersome symptomatology.

Also it is also important to involve the familyIt is also important to involve the family, making them understand that their loved one's symptoms are real, and that they should be supportive and understand that it is not a simulation to get attention or that they are complaining about nothing.

We find 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 the symptoms associated with movement and prevent possible complications.. Regular movement of the arms and legs avoids the stiffness and Muscle weakness that can occur in cases of paralysis or loss of mobility. The gradual increase of exercise provides greater autonomy to the patient.

2. Speech therapy and the oral-phonatory apparatus

With the help of a speech therapist can be addressed the symptoms that comprise problems in speaking or swallowing.

3. Stress reduction and distraction techniques

Various techniques can be used to reduce the patient's stress. Among these techniques are 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, by taking their attention away from their bothersome somatic symptoms and occupying their mind with other tasks.. This can be achieved by listening to music, talking to other people or intentionally changing the way they walk and move.

4. Cognitive-behavioral therapy

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

Cognitive-behavioral therapy can be 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...

5. Pharmacology

Medications are not considered to be effective for the treatment of functional neurological disorders. In fact, the U.S. Food and Drug Administration (FDA) does not approve any drugs specifically as treatments for these neurological conditions.

However, it is believed that antidepressants may be useful in the case of depression or a neurological disorder, it is thought that antidepressants may be useful in the presence of depression or a mood disorder that influences the severity of the disorder..

Visibility of these disorders

Despite being considered the second leading cause of consultation in neurology services, functional neurological disorders have little public recognition, both in medical circles and among the general population, which means that these disorders are often suffered from loneliness and incomprehension.

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

Since 2012, the International Day for 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. The aim is to combat the stigma often suffered by patients with functional neurological disorders, since it is still widely believed that if there is no organic cause to explain it, the symptoms are a simulation.