Functional neurological disorder

Shirin has danced Kathak since she was six. Two weeks before her solo at the Shilpakala Academy, her legs gave way on the rehearsal-room stairs. The neurologist ordered an MRI, then blood tests, then a nerve study. Everything was normal. A relative said, kindly, that it must be in her head. She has stopped telling people how frightening it is to stand.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding functional neurological disorder

Sometimes the nervous system develops real symptoms, such as weakness, numbness, shaking, seizures, loss of speech or vision, without damage to its structure. The problem is in how the brain and body are working, not in their parts; one doctor’s comparison is a computer with healthy hardware and a software fault. Older textbooks called this conversion disorder. Today it is usually called functional neurological disorder, and in the WHO’s classification, dissociative neurological symptom disorder.

Stress and past difficulties can play a part, but not always, and the symptoms are never faked. People who have them are not imagining them.

Signs and symptoms of functional neurological disorder

• Weakness, shaking, attacks resembling seizures, or loss of sensation with normal tests
• Symptoms that vary with attention or distraction
• Repeated investigations without an answer

Treatment for functional neurological disorder

Treatment begins with a clear, believable diagnosis, made by recognising positive signs of a functional problem, not just by ruling everything else out. It usually combines explanation, rehabilitation such as physiotherapy, and psychological therapy, with doctors from different specialties working together. As a psychiatrist, Dr. Tajreen works alongside neurologists rather than instead of them.

What getting better can look like

Shirin’s turning point may simply be being believed. From there, standing becomes a skill to retrain, one step at a time, and then a step to music.

Common questions about functional neurological disorder

Is functional neurological disorder the same as faking it?

No. The symptoms of functional neurological disorder, such as weakness, shaking, seizures or loss of sensation, are real and are never faked. The problem is in how the brain and body are working, not in damage to their structure. Stress and past difficulties can play a part, but not always.

How can FND be diagnosed if all my tests are normal?

Functional neurological disorder is diagnosed by recognising positive signs of a functional problem, such as Hoover’s sign, where a weak leg moves normally when attention is drawn elsewhere, not only by ruling everything else out. Normal tests are part of the picture, not the whole of it. Any new weakness, numbness or seizure should always be assessed medically first.

When to see a psychiatrist

If you have real symptoms and normal tests, you deserve an explanation and a plan. Any new weakness, numbness or seizure must always be assessed medically first.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Perez et al., Journal of Neuropsychiatry and Clinical Neurosciences, 2021 (PMID 32778007)
• World Health Organization, ICD-11, dissociative neurological symptom disorder