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Part 3

You may be surprised that anyone can be vulnerable to FND, and while there are a number of factors that are known to increase risk, these are neither definitive nor exclusive and there is still no consensus on precisely what causes the disorder to manifest. However, when considering a patient with FND, it’s useful to evaluate them against the 3Ps of the cognitive behavioural model:
Predisposing (factors): illness; personality traits; life events; stressors

Precipitating (triggers): injury; traumatic event (either physical or psychological)

Perpetuating (symptoms): what keeps the symptoms alive? Fatigue, chronic pain, illness beliefs, co-morbidities (anxiety/depression) social stressors and also being within the compensation process.

More commonly, people diagnosed with FND will relate to a number of the above.

What are the signs and symptoms we need to be looking for? 
Since classification is clearer and patients can now gain an unequivocal FND diagnosis, how does this look in practical terms?

As we have seen across Reach, FND clients can experience a wide range and combination of symptoms that are physical, sensory and/or cognitive. This is where the rehab approach needs to be focussed and the assessment needs to be very specific to gain an accurate baseline.

Typical symptoms:
There are a range of typical signs and symptoms within the disorder, the more common ones come under three clinical headings.

Motor dysfunction:
Functional limb weakness and paralysis
Functional movement disorders including tremor, spasms and jerky movements – all leading to problems with walking
Functional speech symptoms including slurred or stuttering speech in addition to whispering speech (dysphonia).

Sensory dysfunction:
Functional sensory disturbance which includes altered touch sensation including numbness, tingling or pain in the face, torso or limbs, (this often occurs unilaterally, which has been the case with several Reach FND patients)
Functional visual disturbances, including loss of vision or double vision.

Cognitive symptoms
Dissociative (non-epileptic) seizures presenting as blackouts and faints
Fatigue – cognitive and physical
Sleep problems
Anxiety
Memory problems
Low mood
Problems with planning/organising.

It is important to remember that these symptoms are quite real and often very disabling, and can co-exist alongside a diagnosable neurological condition (in around 10 – 20 per cent of cases).

Stay Tuned for Part 4, when we look at the Key points and Best Practice for the rehabilitation pathway.