Functional Neurological Disorders

Banner Brain & Spine’s neurologists are experts in treating patients suffering from neurological conditions, including functional neurological disorders. We take a compassionate, collaborative and highly personalized approach to your care. Our experienced team is dedicated to getting you answers and solutions quickly, so you can start feeling better and experiencing relief.

What Is Functional Neurological Disorder (FND)?

Although relatively common, most people haven’t heard of functional neurological disorder (FND), also known as conversion disorder. FND is a group of debilitating medical conditions that affect the brain and nervous system. FND is a very real disease with symptoms that cause significant distress and disability if left untreated.

A functional neurological disorder is diagnosed when a patient has neurological and psychiatric symptoms that can’t be explained by a known neurological disorder or medical disease.

Patients with FND experience a wide variety of neurological symptoms, including limb weakness, seizures, numbness and vision problems.

FND can be hard to understand. Symptoms differ patient-to-patient and can mimic other medical and mental health illnesses. FND can be attributed to biological, environmental and psychological vulnerabilities; however, their exact causes are unknown.

Banner Brain & Spine’s multidisciplinary team is experienced in evaluating and caring for patients with FND and their families. With early diagnosis and treatment, successful recovery is possible. 

Types of Functional Neurological Disorders

• Glossopharyngeal neuralgia: A disorder causing severe pain in the tongue, throat, larynx, ears and tonsils.
• Trigeminal neuralgia: Trigeminal neuralgia, also known as tic douloureux, is a chronic pain disorder that affects the trigeminal nerve (fifth cranial nerve), which is one of the largest nerves in the head. It is characterized by sudden, severe facial pain that may feel like an electric shock. The pain is often triggered by normal activities such as speaking, eating, or touching the face. It can last for several seconds to a few minutes at a time. It can happen repeatedly for up to two hours. Trigeminal neuralgia is a rare condition that typically affects people over the age of 50 and it is more common in women than in men. The exact cause of trigeminal neuralgia is not fully understood, but it is often associated with compression of the trigeminal nerve by blood vessels or other structures. It is usually treated with medications and procedures that aim to block the pain signals from the nerve. In some cases, surgery may be needed to correct the underlying cause of the pain.
• Hemifacial spasm: Hemifacial spasm is a neurological disorder characterized by involuntary contractions of the facial muscles on one side. These contractions can range from mild twitching to severe spasms and may occur frequently or infrequently. It usually starts with twitching of one eyelid and then spreads to the lower face. Eventually, the eye is forced closed and the mouth may be pulled to one side.  Hemifacial spasm is usually caused by irritation or compression of the facial nerve (seventh cranial nerve) and can sometimes be associated with an underlying condition such as a brain tumor or an abnormal blood vessel. Treatment options for hemifacial spasm may include medications, botulinum toxin (Botox) injections, and surgery to remove the cause of the nerve irritation.  
• Essential tremor: Essential tremor is a neurological disorder that causes involuntary and rhythmic shaking or trembling of certain parts of the body, most commonly in the hands, head and voice. It is the most common type of tremor and affects millions of people worldwide. Essential tremor can occur at any age, but it typically develops in people over the age of 40. The exact cause of essential tremor is unknown, but it is thought to be related to problems with certain brain areas that control movement and often runs in families. Symptoms of essential tremor can vary from person to person. They may include: tremors that occur when the affected body part is at rest, tremors that get worse when the body part is used and tremors that improve with movement or with other activities. It differs from Parkinson’s disease as essential tremor occurs without other neurological symptoms. Treatment options for essential tremor may include medications to control tremors, lifestyle changes (such as avoiding caffeine and alcohol), and certain medical procedures (such as deep brain stimulation). 
• Parkinsonian: Most patients with Parkinson’s disease experience tremors. Parkinson’s tremors are rhythmic (slow, continuous), tend to start on one side of your body and happen when your muscles are still. 
• Tethered cord: A tethered cord is a condition in which the spinal cord becomes attached to the surrounding tissues in the spinal column, causing it to become stretched and unable to move freely within the spinal canal. This can lead to a variety of problems, including problems with bowel and bladder function, leg weakness, and problems with balance and coordination. Tethered cord is often associated with spinal abnormalities, such as spina bifida, and it can occur at any age. Treatment for tethered cord may involve surgery to release the attachment and allow the spinal cord to move freely within the spinal canal.

What Causes Functional Neurological Disorder?

The exact cause of FND is unknown. They involve a problem with the part of your brain controlling your muscles and senses. Triggers for symptoms can't always be identified, but sometimes it occurs after a stressful event, emotional distress or physical trauma.

FND Risk Factors 

FND can affect anyone, at any time. However, FND is uncommon in children under 10 and affects more women than men. Research points to factors that may make some patients more prone to FND, including having a:

• Neurological disorder, such as epilepsy or migraines
• Mental health condition
• Close relative with FND

FND Prevention

There is no known way to prevent functional neurological disorder. 

What Are Signs and Symptoms of FND?

It can be difficult to correctly diagnose FND. Patients with FND can have a wide range and combination of physical, sensory, emotional and cognitive symptoms. Symptoms can vary day-to-day and can happen continuously or sporadically. Some patients also may experience long periods of being symptom-free.

The most common symptoms of FND include:

• Difficulty swallowing 
• Difficulty walking
• Hearing issues, including hearing loss, or deafness
• Loss of balance
• Loss of consciousness/fainting
• Numbness 
• Periods of unresponsiveness
• Seizures or shaking
• Speech problems, such as a soft voice or slurred speech
• Tremors 
• Vision problems, such as double vision or blindness
• Weakness or paralysis

FND symptoms are similar to other neurological disorders and it’s common for patients to have FND and other conditions such as stroke, depression and fibromyalgia.

If you are experiencing any of these symptoms, talk to your doctor right away. Early diagnosis and treatment are important to effective treatment and recovery. 

How Is a Functional Neurological Disorder Diagnosed?

Banner Banner Brain & Spine’s neuroscience team are experts in diagnosing and treating patients with FND. Our approach includes medical and mental health professionals to accurately provide a FND diagnosis.

A diagnosis of FND is primarily based on symptoms. Although the patient is experiencing symptoms, brain imaging tests (EEG, MRI, CT scan) won’t show any abnormalities or changes. For these reasons, it’s important to seek a diagnosis from a neurologist who has experience with FND.

FND Testing 

FND requires an evaluation and diagnoses from a neurologist, including: 

• Review of health history and symptoms analysis
• Physical exam
• Neurological exam
• Psychiatric exam
• DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) evaluation looking to see if:
  • Symptoms are affecting movement or senses
  • Symptoms can't be explained by another neurological, medical or mental health condition 
  • Symptoms are causing significant distress or disruption to daily activities

FND Prognosis 

If left untreated, FND can have a devastating long-term impact on a patient’s quality of life. The severity of symptoms can be debilitating and affect a patient’s ability to work, socialize and care for themselves. However, with proper diagnosis and treatment, Banner Brain & Spine doctors are able to help patients manage and improve their symptoms and live their lives to the fullest.

How is Functional Neurological Disorder Treated?

Treating functional neurological disorder starts with your doctor giving you a clear explanation of your diagnosis. Understanding that FND is a relatively common condition and that symptoms can improve over time helps to reduce anxiety.

Banner Brain & Spine’s expert team builds each patient with FND an individualized treatment plan. These treatment options may include:

• Psychoeducation
• Psychotherapy
• Cognitive behavioral therapy (CBT)
• Behavioral interventions
• Hypnosis
• Medication
• Transcranial magnetic stimulation (TMS)
• Physical therapy
• Virtual reality 
• Microvascular decompression (MVD): A complex surgical procedure to treat hemifacial spasms and trigeminal neuralgia. A small incision is made behind the ear to separate the blood vessels that are pressing on the trigeminal nerve or other nerves in the face. This can help to relieve the pain and spasms associated with these conditions. MVD is usually considered a safe and effective treatment. It does carry some risks, such as bleeding, infection and changes in facial sensation or muscle function. 

Members of your medical team may include a neurologist, psychiatrist, speech, physical and occupational therapists and others. It’s also important you have regular follow-up with your medical team to monitor your recovery and make changes to your treatment plan as needed.

FND Support

Connecting with others with FND can help with recovery.