Due to the diversity of symptoms that may present with a Functional Neurological Disorder, and the varied potential causes/triggers that can differ from person to person, treatment plans should be tailored to suit the person’s individual need, with ALL health aspects being taken in to consideration. There is not a ‘one fix will fix all’ option, which can cause frustration for both the person with the diagnosis and clinicians, so it may take time to develop the correct treatment plan.
Historically the only form of treatment offered to those diagnosed with FND was psychotherapy given the misinterpretation that emotions were being ‘converted’ to physical symptoms. Due to lack of current understanding, this is still often the case even if it may not be a necessary course of treatment. Different treatment options are becoming more available, and in many cases proving to be more successful. Such as specialist physiotherapy for movement/motor symptoms.
FND Action advocate for the need for collaborative care to be available and accessible, to give a person who has been diagnosed the best chance of recovery/management of symptoms.
FND is not classed as degenerative, however symptoms for people can become chronic or worsen. Recovery and/or symptom management is possible, however it may be dependent on triggers of symptoms, comorbidities, and being able to access appropriate treatment.
Evidence is growing that Neuro-physiotherapy can be the most effective treatment for those who have movement or motor symptoms such as weakness and walking difficulties. This type of therapy focuses on regaining normal function, aka retraining the brain, rather than being focused on exercise.
If a Physiotherapist has limited/no knowledge of FND, this publication may be helpful: Physiotherapy for functional motor disorders: a consensus recommendation
Other therapies, such as speech and language, may be needed within the collaborative care depending on symptoms.
Emotional health is equally as important as physical health, and as with many, if not most, commonly-known neurological conditions, can play a significant roll in recovery and/or management of symptoms. Neuro-psychotherapy can help with dealing with past emotional trauma such as PTSD, existing emotional health difficulties such as anxiety and stress, memory and cognition problems, and provide support and guidance with how to cope with life changes due to poor health. This can be delivered in several forms such as Cognitive Behavioural Therapy (CBT), Mindfulness, Eye Movement Desensitisation and Reprocessing (EMDR) and talking therapy. This is particularly relevant to people who suffer from dissociative seizures and other symptoms that are possibly triggered by factors that are known to cause disruption to how the nervous system functions.
People report often that Grounding techniques help them to manage/relieve symptoms. Whilst the link relates to seizures, it can also be effective for those with movement/motor symptoms and conditions such as chronic pain. Pacing has also reportedly helped some with managing and/or relieving symptoms.
An Occupational Therapist’s role is to assess and support a person’s practical needs (short or long term) with everyday living whilst symptomatic. This could be aids needed for physical difficulties, help with maintaining the home and undertaking tasks, help with physical activity, and support getting back to work. Occupational therapy can play a significant role in treatment to assist with regaining normal bodily function. For further reading this publication may be helpful: Occupational therapy consensus recommendations for Functional Neurological Disorder
There is no recognised or approved medication to treat FND, however antidepressants and pain medication may be prescribed to help relieve possible triggers or co-existing conditions. Whilst they may be offered to help relieve symptoms, it is imperative that the administration is managed whilst taking them by a medical professional. Antidepressants, or anti-anxiety medications, should only be considered for short-term use. If a person still remains symptomatic whilst taking medication it may not be suitable or necessary, or the correct dosage. A person taking any form of medication should always be made fully aware of potential side effects, both whilst the person is taking them and if/when they stop taking them.
FND Action advocate that ALL people diagnosed with Functional Neurological Disorder should have their health managed by a consistent primary health provider whilst symptomatic. This health provider should work with other clinicians and support workers to follow a collaborative care programme, and adhere to the Patient experience in adult NHS services Quality standard [QS15]
When a person is diagnosed with a medical condition, it not only affects the person diagnosed but also those close to them. A partner or family member may become a carer, and other family members and friends may provide physical and emotional support. It is important that they are part of the collaborative care team. They can help to advocate for the person diagnosed and support them. For example engage at doctor’s appointments, and help with medication management. It is important that care givers receive support and guidance themselves also. You can read further information on our Carer’s page.
Some people have found symptom relief from exploring alternative treatments. Here is a selection you may like to consider, some of which may be available through the NHS. You can search the internet for websites which explain the treatment, how it may help, and what services are available in your area. It is recommended you consult a doctor if you are considering any alternative treatments.
Acupuncture is a therapeutic treatment that involves inserting thin needles in to the skin to stimulate nerves and muscle tissue.
Acupressure involves applying physical pressure on the body by the hand, elbow, and other appropriate devices.
Chiropractic involves using the hands to manipulate the spine, other joints, and soft tissues.
EFT (emotional freedom techniques), also called tapping, is a form of psychological acupuncture. It involves simple tapping techniques using the fingertips on different parts of the head and body.
Herbal medicines are a type of dietary supplement using herbs and spices as an alternative/additional treatment option.
Hydrotherapy is a therapeutic treatment that involves exercise and movement in water.
Hyperbaric oxygen therapy involves breathing oxygen through a mask in a pressurised chamber.
Hypnotherapy is a complimentary therapy which uses verbal communication whilst a person is hypnotised, as in a state of deep relaxation. The power of positive suggestion can then be used to bring about a subconscious change to our thoughts, feelings and behaviour.
Music therapy has been reported in many studies to be good for our health, and in particular for managing chronic conditions and emotional health problems. This could involve listening to music, singing or playing an instrument.
Yoga is a holistic form of exercise involving posture and breathing.
Finally, bear in mind your body is like a car. To make it go it needs petrol and the right type of oil, and it needs to be used regularly so the parts don’t seize up or stop working. Here are some document downloads that may help get you started in considering your self-care, exercise and diet.
Self-care Starter Kit (The Blurt Foundation)
Doing Sport Differently (Disability Rights UK)
The Eatwell Guide (Public Health England)
The FNDS has been set up by worldwide leading specialists, to bring together medical professionals who treat people who are diagnosed with functional neurological symptoms.
For further information, and details on how to sign up, please visit https://www.fndsociety.org