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FND is in a category of functional disorders that primarily comes from within the functioning of the nervous system, as opposed to any identifiable pathophysiological disease, which is something it shares with both irritable bowel syndrome and fibromyalgia. Dr Bichard of The Walton Centre describes it as “a problem with the functioning of the nervous system in a structurally normal brain”. Professor Jon Stone et al use the relatable analogy, in their highly recommended paper ‘Recognising and explaining functional neurological disorder’, of calling it a “Software rather than a hardware problem”.
Diagnosis was previously one of exclusion, which left questions looking for answers, some of which could be provided by psychoanalysis. Relatively recent developments that have increased our understanding of FND have meant that diagnosis is now arrived at from positive, rule-in signs that can be determined by tests performed under the direct supervision of a neurologist or a neuropsychiatrist, with the presence of psychological stressors being recorded as an adjunct to any of the accepted criteria. All of the accepted positive motor signs for FND are neatly presented in tabular form in the Aybek and Perez review. Prof. Stone (Stone et al, 2009) also highlight the low misdiagnosis rate of less than five per cent, cautioning against fear of misdiagnosis.
In part three, we’ll look at who is vulnerable to developing FND….