🧠 Functional Neurological Disorder (FND): Better Understanding for Better Treatment
What is FND?
Functional Neurological Disorder (FND), previously known as conversion disorder, is a condition in which a person presents neurological symptoms affecting movement, sensory functions, or cognition. These symptoms resemble those of neurological diseases but occur without any detectable structural abnormality in the brain or nerves.
FND results from a disruption in communication between different areas of the brain. The symptoms are real and disabling—sometimes just as severe as those caused by other neurological conditions.
Fortunately, recent neuroscience research shows that FND is often reversible, especially when treated by a specialized care team.
🧠 Common Symptoms
- Muscle weakness or paralysis
- Tremors and abnormal movements
- Walking difficulties
- Non-epileptic seizures
- Sensory disturbances (vision, hearing, touch)
- Cognitive symptoms (memory or attention problems)
- Functional speech disorders
⚠️ Risk Factors
- History of stress or trauma
- Anxiety or depressive disorders
- Burnout or significant life events
- Heightened bodily awareness (hypervigilance)
- Sometimes no identifiable factor
🧬 Pathophysiology
FND overlaps with other somatic symptom disorders described in the DSM-5, such as fibromyalgia, chronic fatigue syndrome, and functional gastrointestinal disorders. Some cases of chronic mild traumatic brain injury and long COVID may actually be undiagnosed FND.
- Disturbance in agency (the sense of control over one’s own actions)
- The role of attention in symptom expression
- Dissociative experiences may be more frequent in some individuals
Agency refers to our sense that we are initiating and controlling our movements. This perception can be disrupted by dysfunction in a brain region called the right temporoparietal junction, which integrates sensory information and plays a key role in body awareness.
🔎 How is FND Diagnosed?
Diagnosis is made by a neurologist experienced with FND, based on two key principles:
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Exclusion of other neurological diseases
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Identification of positive clinical signs that are typical of FND
According to the DSM-5-TR, the diagnostic criteria include:
- At least one symptom affecting voluntary motor or sensory function
- Clinical incompatibility with known neurological conditions
- Significant functional impairment
- No better medical explanation
The neurologist will also assess for inconsistency and incongruence in symptoms—two essential clues to accurate diagnosis.
🧰 How is FND Treated?
There is no single treatment, but a personalized, multidisciplinary approach has proven to be the most effective. The goal is to retrain the brain to properly regulate motor, sensory, and cognitive functions.
🎓 1. Patient Education: Understanding FND helps reduce anxiety, challenge false beliefs, and improve engagement with treatment. It is essential to emphasize that symptoms are real, common, and often reversible.
🧑🦽 2. Functional Rehabilitation: kinesiology, occupational therapy, and speech-language therapy, depending on the symptoms.
🧠 3. Cognitive-behavioral therapy, mindfulness-based approaches, acceptance therapy, or clinical hypnosis may be used.
💊 4. Medication. Medication does not act on motor symptoms directly but may be prescribed to manage co-occurring anxiety, depression, or insomnia.
🧪 5. Innovative Interventions (under study): Biofeedback, mirror therapy, virtual reality therapy, and functional electrical stimulation.
🏥 The Neuro-Concept Approach
At Neuro-Concept, we offer a specialized program for individuals living with FND, including:
- A comprehensive interdisciplinary evaluation
- A personalized treatment plan
- Support for family and caregivers, to improve understanding and reduce stigma
Functional neurological disorders are common, real, and treatable. Early, specialized, multidisciplinary care significantly increases the chances of long-term recovery.