Functional neurological disorder (FND) is a medical condition in which there is a problem with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process such as multiple sclerosis or stroke.Cognitive learning theory in the classroom FND can encompass a wide variety of neurological symptoms, such as limb weakness or seizures.

FND is a condition at the interface between the specialties of neurology and psychiatry.Cognitive learning theory in the classroom conventional tests such as MRI brain scans and eegs are usually normal in patients with FND. This had led, historically, to the condition being relatively neglected by both clinicians and researchers.Cognitive learning theory in the classroom however, it is now established that FND is a common cause of disability and distress, which may overlap with other problems such as chronic pain and fatigue.Cognitive learning theory in the classroom encouraging studies support the potential reversibility of FND with specifically tailored treatments. New scientific findings are influencing how patients are diagnosed and treated which is creating an overall change in attitude towards people with FND.Cognitive learning theory in the classroom

Older ideas that FND is “all psychological” and that the diagnosis is made only when someone has normal tests have changed since the mid-2000s.Cognitive learning theory in the classroom the new understanding, including modern neuroscientific studies, has shown that FND is not a diagnosis of exclusion. It has specific clinical features of its own and is a disorder of the nervous system functioning in which many perspectives are necessary.Cognitive learning theory in the classroom these vary a lot from person to person. In some people, psychological factors are important, in others they are not.

The exact cause of FND is unknown, although ongoing research is starting to provide suggestions as to how and why it develops.Cognitive learning theory in the classroom many different predisposing factors can make patients more susceptible to FND such as having another neurological condition, experiencing chronic pain, fatigue or stress.Cognitive learning theory in the classroom however, some people with FND have none of these risk factors.

At the time FND begins, studies have shown that there may be triggering factors like a physical injury, infectious illness, panic attack or migraine which can give someone the first experience of the symptoms.Cognitive learning theory in the classroom these symptoms normally settle down on their own. However, in FND the symptoms become ‘stuck’ in a ‘pattern’ in the nervous system. That ‘pattern’ is reflected in altered brain functioning.Cognitive learning theory in the classroom the result is a genuine and disabling problem, which the patient cannot control. The aim of treatment is to ‘retrain the brain’, for example by unlearning abnormal and dysfunctional movement patterns that have developed and relearning normal movement.Cognitive learning theory in the classroom

One way of thinking about FND is looking at it as a bit like a ‘software’ problem on a computer. The ‘hardware’ is not damaged but there is a problem with the ‘software’ and so the computer doesn’t work doesn’t work properly.Cognitive learning theory in the classroom conventional structural MRI brain scans are usually normal in FND unless the person has another neurological condition. Functional’ brain scans (fmri) are starting to provide early evidence for how the brain goes wrong in FND.Cognitive learning theory in the classroom fmri scans show changes in patients with FND which look different from healthy patients without these symptoms as well as healthy people ‘pretending’ to have these symptoms.Cognitive learning theory in the classroom functional imaging is still a research tool and is not developed enough to be used in the diagnosis of FND. Scans support what patients and researchers already know – these are genuine disorders in which there is a change in brain functioning, which is out with the control of the person with FND.Cognitive learning theory in the classroom

Historically, FND has traditionally been viewed as an entirely psychological disorder in which repressed psychological stress or trauma gets ‘converted’ into a physical symptom.Cognitive learning theory in the classroom this is where the term ‘conversion disorder’ comes from. Psychological disorders and stressful life events, both recent and in childhood, may be risk factors for developing the condition in some patients, but they rarely provide a full explanation for the cause of the condition and are absent in many patients.Cognitive learning theory in the classroom patients do not have to be depressed, anxious or the survivor of adverse childhood experience to develop FND.

Modern theories propose that FND has many causes, which vary from patient to patient.Cognitive learning theory in the classroom one comparison is to think about heart disease. There are lots of causes of heart disease – smoking, genetic factors, diet and even stress-related / psychological factors such as depression.Cognitive learning theory in the classroom smoking may be a factor in heart disease in many people, but it is not in everyone. The same analogy can be made for FND. In some psychological factors such as past trauma or stress at the time of symptom onset in FND are important in understanding how the brain has gone wrong.Cognitive learning theory in the classroom in others the presence of a problem like migraine or a physical injury may be the most important thing.

When it goes well, understanding the diagnosis enables the patient to see that they have a genuine and relatively common condition which has the potential for improvement over time.Cognitive learning theory in the classroom this creates a foundation for treatment to build upon. Written information, like that available at www.Neurosymptoms.Org or www.Fndhope.Org may help individuals comprehend this complex and difficult to understand disorder.Cognitive learning theory in the classroom

Evidence is now emerging for the efficacy of certain treatments, especially physiotherapy for motor symptoms and a type of psychological therapy called cognitive behavioral therapy (CBT) for attacks or seizures.Cognitive learning theory in the classroom specialized types of physiotherapy and CBT have been developed for FND. Other therapies such as speech therapy and occupational therapy may also have a role depending on the symptoms.Cognitive learning theory in the classroom

For patients with motor symptoms such as limb weakness, gait problems or movement disorder, physical therapy from a therapist who understands something of FND can be helpful.Cognitive learning theory in the classroom physiotherapy approaches are active treatments that focus on retraining movement patterns that have gone wrong. There is some evidence from clinical trials that physiotherapy designed specifically for FND can be helpful for some patients.Cognitive learning theory in the classroom in recent years we have learned that physical therapy for FND is different from that used for stroke or MS in many ways. For example, patients with stroke benefit from being asked to focus on the affected body part, whereas in FND that tends to make things worse.Cognitive learning theory in the classroom physical therapy for FND promotes ‘automatic movements’ and reduces the abnormal brain patterns that have been interfering with movement.

CBT is generally the first line of treatment for patients with dissociative (non-epileptic) seizures or attacks as part of their FND and is supported by clinical trials.Cognitive learning theory in the classroom therapy includes time to learn more about their attacks and recognizing brief warning symptoms and learning techniques to regain control. For some patients it is helpful to look more widely at thoughts, emotions, and experiences that could have played a role in the development of symptoms.Cognitive learning theory in the classroom for those patients without anxiety and depression, psychological therapy may still be useful in regaining confidence. FND itself is often experienced as a stressful condition to manage and live with.Cognitive learning theory in the classroom other types of psychological therapies can also be used depending on the individual patient, e.G. Psychodynamic interpersonal therapy (PIT) or more trauma-focused work for patients who have had such experiences.Cognitive learning theory in the classroom