Very often, at a doctor’s appointment, the patient complains of numbness, pain, gait disturbance, fainting, and other neurological symptoms. Still, even the most experienced neurologist does not find signs of organic damage to the nervous system in the patient. In this case, we can talk about a functional neurological disorder.
Why is this happening? With all functional neurological disorders, we are not talking about organic damage to the nervous system, which you can see with magnetic resonance imaging or other examination methods.
- For numbness and pain symptoms, the problem may be that the brain does not receive signals from the body.
- In violation of gait in violation of the transmission of signals from the brain to the body.
- In functional fainting, the brain is in a state similar to hypnosis.
For comparison, we can give an example with a computer in which all blocks and boards are in good working order, but there are problems with the software. Such a computer will work slowly, intermittently. But disassembling it, we will not be able to find a breakdown. To fix such a computer, you need to find out which programs are malfunctioning. A person is much more complex than a computer, but, by analogy, our thoughts, feelings, emotions, and behavior are programs.
Most patients suffering from the functional neurological disorder have many complaints:
- General weakness.
- Increased fatigue.
- Pain in the back, trunk, limbs.
- Sensitivity disorders.
- Involuntary movements.
- Gait disorders.
- Speech disorders.
- Memory / concentration impairment.
- Difficulty finding words.
- Sleep disturbances.
- Visual impairment.
- Swallowing disorder.
- Violation of urination.
- Bowel problems.
- Reduced mood.
- Health anxiety.
What are functional neurologic disorders?
In the practice of a neurologist, there are many diseases:
- Multiple sclerosis.
- Brain tumors.
- Parkinson’s disease.
- Myasthenia gravis.
- Amyotrophic lateral sclerosis.
Specific neurological symptoms characterize each neurological disease. At the same time, the number of neurological symptoms is limited, and each is not strictly specific for anyone’s neurological disease and can occur in many diseases.
The combination of various neurological symptoms in functional neurological disorder makes the picture of the disease incomprehensible and frightening, both for the patient and for the doctor.
- A person who does not have special medical education and a doctor who does not have experience working with such patients may misinterpret the existing symptoms and suspect that a person with functional impairments has any serious disease in which these symptoms occur.
- At the other extreme, patients with functional impairments are often not believed; they say they have invented everything, have no pathology, and everything that has happened is the fruit of a wild imagination or simulation.
The problem is aggravated by the fact that the patient may have a combination of neurological diseases and functional disorders; for example, the presence of psychogenic seizures in a patient with epilepsy or the presence of psychogenic dizziness in a patient with benign paroxysmal positional vertigo.
With a functional neurological disorder, the patient does not have an organic lesion of the nervous system, but their complaints are far from a figment of a violent imagination. In the development of functional disorders, the main role is assigned to psychological factors. Functional symptoms exist on the border between the brain and the psyche, neurology, and psychiatry. It is no coincidence that dissociative disorder, psychogenic disorder, psychosomatic disorder, somatization disorder, and hysteria are used to define functional disorders. These definitions emphasize that the problem is caused by the influence of the human psyche on his body.
Treatment principles for a functional neurological disorder
Most neurologists find it challenging to interpret the patient’s numerous complaints, which causes patient discontent and frequent doctor changes. If such a patient gets to a psychiatrist, the psychiatrist also feels insecure, but has the neurologist missed any severe neurological disease?
The treatment of functional neurological disorder can be performed by neurologists and psychiatrists who have experience working with such patients, specializing in functional neurological disorder.
- The key point in treating the functional neurological disorder is the patient’s understanding of their diagnosis. In some cases, patients do not want to believe that the disease is psychogenic and become defensive. However, functional disorders often occur for no apparent reason. And stress is just a response to a problem. At this stage, the doctor’s task is to help the patient understand that it is precisely stress due to the existing symptoms that are the main problem that needs to be addressed at present.
- The next task of the doctor is to identify moments in the patient’s behavior that interfere with recovery and select behavior that will contribute to a speedy recovery. For example, a physician may recommend that a patient with chronic pain or chronic fatigue gradually increase physical activity. Regular feasible physical activity leads to an improvement in the condition. On the contrary, prolonged bed rest, irregular or excessive exertion can aggravate the condition. If the patient cannot cope with restrictive behavior independently, the doctor may recommend cognitive behavioral therapy.
In some cases, functional neurological disorder can be cured without pills. However, for a speedy recovery, the doctor may recommend that the patient take medication.
For functional disorders, the following groups of drugs are used:
- Anticonvulsants (antiepileptic drugs).
- Sleeping pills.
The goal of drug treatment is to reduce functional disorders, relieve pain, normalize mood, relieve anxiety and fatigue.
The drug should be taken for a long time, in some cases regularly, to achieve a lasting improvement in the condition. Nobody wants to take pills for a long time, especially regularly.
- Some patients do not understand the meaning of taking antidepressants. However, these drugs are used worldwide to treat pain, sleep disturbances, irritable bowel syndrome, neurogenic bladder, etc. And this effect manifests itself regardless of whether a person has depression or not.
- Some patients are afraid of drug dependence, addiction. Antidepressants should not be confused with benzodiazepine tranquilizers, codeine, and some hypnotics. There is no evidence that antidepressants or antiepileptic drugs are addictive; that is, a person begins to take more and more of them to achieve the same effect. It happens that with a fast withdrawal of an antidepressant, unpleasant symptoms of a temporary nature occur. The attending physician will teach the patient how to properly reduce the dose and cancel the drug for this not to happen.
- Some patients already have a negative experience of taking such drugs, side effects or no effect. Side effects (nausea, increased anxiety, drowsiness) are certainly possible at the beginning of the dose, but they are temporary and easily stopped.
The insufficient effect may be associated with a low dose or with an insufficient time of administration. The effect of treatment usually becomes noticeable after 3-4 weeks from the start of treatment.
In most cases, patients with functional neurological disorders require the help of a psychotherapist. Psychotherapy, in this case, is not about looking for the cause in distant childhood but about looking for things that interfere with coping with the disease at the moment. That is, psychotherapy is aimed at understanding how the condition can be improved in real-time. Many life problems do not have easy solutions to improve the condition; you need to make an effort.