Conversion/Functional Neurological Disorder

FUNCTIONAL NEUROLOGICAL DISORDER/CONVERSION

The research states that FND is the 2nd most common reason for a neurological outpatient visit after headache/migraine. Despite FND being relatively unknown until recent we have been treating FND for decades.

Functional Neurological Disorder is a newer and broader term that includes what use to be called conversion disorder.   It’s called functional because no neurological or structural conditions exist; they’re all functional.   However, the symptoms cause significant distress or problems functioning.  

FND is neuropsychiatric.  It was Freud who termed it Conversion from its previous term Hysteria; because they use to believe it happened only in females. It is how the branches of neurology and psychiatry were formed.  It is when an emotional or traumatic event has occurred to either themselves or a loved one, and the patient begins exhibiting or mimicking these symptoms despite the fact that the event has passed, but for the patient they still feel like they exist.  

EX. 12 y/o male whos best friend was in a serious car accident is left crippled.  She has nystagmus and tremors.  This young man began exhibiting eyes rolling up into back of head, and shaking trying to unconsciously mimic her symptoms as he helped her return to school.

EX. 55 y/o female who has been told by one neurologist she has MG so she googles it and she starts changing her speech; slurring, ataxic. Another neurologist confirms via autoimmune and blood tests that she is negative for MG.  The patient still states she thinks she has it so she continues with the disabling speech.

Signs and symptoms vary, depending on the type of functional neurological disorder, and may include specific patterns. Typically these disorders affect movement or your senses, such as the ability to walk, swallow, see or hear. Psychogenic Non-Epileptic Seizures (PNES) is very common amongst FND.  Symptoms can vary in severity and may come and go and be in-persistent unlike a pathological case. 

The cause of FND is unknown. The condition may be triggered by a physical, emotional, traumatic or stressful event. FND is functional rather than damage to the brain’s structure (such as from a stroke, multiple sclerosis, infection or injury).

Early diagnosis and treatment and recovery over a week -month versus years is dependent on education about the condition to both the patient and there companion eg. husband, mother, friends etc  

Symptoms

  • Feeling of Weakness or paralysis
  • Abnormal movement, such as tremors or difficulty walking
  • Loss of balance
  • Difficulty swallowing or feeling “a lump in the throat”
  • Seizures or episodes of shaking and apparent loss of consciousness (nonepileptic seizures) known as dissociative seizures.
  • Episodes of unresponsiveness

Signs and symptoms that affect the senses may include:

  • Numbness, tingling or loss of the touch sensation
  • Speech problems, such as inability to speak or slurred speech
  • Vision problems, such as double vision or blindness
  • Hearing problems or deafness

The FND program consists of a 2-hour initial evaluation which translates into an individualized treatment plan for each patient depending on their symptoms and diagnostic results.

Exam includes:

  • Full neurological exam,
  • Autonomic Testing and measurements of Vagus and heart rate variability
  • Balance, Gait exam
  • Cognitive tests
  • Computerized Brain Function testing
  • Videonystagmography (VNG) balance/ vestibular test

TREATMENT:

  • Pons stimulation,
  • Vagus nerve,
  • Trigeminal stimulation.   
  • Vestibular Rehab
  • Neurosensory Integrator https://www.rkbinstruments.com/ 
  • Cognitive rehab
  • Balance and gait training
  • Interactive Metronome https://www.interactivemetronome.com/what-is-im

TRANSCRANIAL DIRECT-CURRENT STIMULATION (tDCS)

  • Galvanic (tDCS) is unlike any other current
  • Has polarity specific effects on neurons.
  • Changes firing threshold and can produce long lasting after effects.
  • Causes neurons to fire by increasing “neuronal excitability”
  • These impulses travel throughout the brain and activate or reactivate neurons and structures involved in human function
Electrical stimulation of the cranial nerves produces neural impulses directly into the brain stem and cerebellum – which is the relay station to the brain and spinal cord.  These impulses travel throughout the brain and activate or reactivate neurons and structures involved in human function
 
We use Transcutaneous vagal (VNS) and trigeminal nerve stimulation, Repetitive Somatosensory Stimulation for those affected by: vestibular and cerebellar disorders, movement disorders, concussion, Cerebral Palsy, Autism, post-stroke, MS and more.

We use Galvanic Vestibular Stimulation for those affected by balance disorders, post stroke rehab and more