FND treatment can begin once a patient’s symptoms are validated, and the patient is diagnosed. The aim of FND treatment is to ‘retrain the brain’, for example by unlearning abnormal and dysfunctional movement patterns that have developed and relearning normal movement.
Most experts advocate a multidisciplinary approach to FND treatment because of the variety of symptoms the disorder encompasses. Multidisciplinary treatment means that a range of medical specialties will be involved in treatment. These specialties can include neurology, physiotherapy, psychiatry/psychology, occupational therapy or any other specialty that patients may benefit. Ultimately, the best approach allows treatment to be tailored to the individual.
Evidence is now emerging for the effectiveness of certain FND treatments, especially physiotherapy (for motor symptoms) and psychotherapy (for attacks or seizures) that have been specifically tailored for FND.
For effective and sympathetic FND treatment, it is critical to acknowledge that FND is a genuine disorder in which symptoms are experienced as out of the person’s control. The most common mistake by both public and health care professionals is that FND patients are in control of some or all of their symptoms. FND is often misunderstood because movements may be controlled when the patient is distracted, as previously mentioned. These features can lead health professionals or friends and family to wonder if the symptoms are feigned or ‘made up’. However, the patient does not consciously produce functional symptoms. Various scientific studies also provide evidence that functional symptoms are not feigned and cannot be turned on and off at will.
A Doctors Perspective: FND Treatment Options
Written by Professor Mark Edwards
In illness in general there are not many different treatment options. There are medical treatments (drugs), surgical treatments, physical treatments (physiotherapy, occupational therapy, rehabilitation) and cognitive/psychological treatments (e.g. cognitive behavioural therapy (CBT), psychotherapy). There are in addition complementary medical treatments such as acupuncture, therapeutic massage, hypnosis, homeopathy.
Given the nature of FND it should be obvious that medical and surgical treatments are unlikely to have much of a role in treatment for most people, as these treatments have largely been developed for problems resulting from structural or degenerative neurological disease. I most commonly use medication as treatment for other medical conditions which happen to affect a person with FND. For example, I see quite a lot of people with FND who have chronic migrainous symptoms, and so I use migraine preventative medications for these people to try to help these symptoms. I see some people with FND who have depression in addition or obsessive compulsive disorder, and so I might use medical (or more commonly cognitive) treatments to help with this problem. I see this as in general “reducing the demand on the system”. In other words that if a person with FND also has chronic migraine then successful treatment of the migraine may well make the FND improve as the overall demand on the system has been reduced by treating the other medical problem.
Sometimes treatment occurs in the setting of “multidisciplinary rehabilitation” where people with FND are often admitted to hospital for a period of time (for example 4-6 weeks) to have regular CBT, specialist physiotherapy and occupational therapy. This sort of treatment is most useful for people who have severe and complex symptoms where, for example, they would be unable to attend outpatient treatment because of the level of their disability. There other similar programs for people who have dominant symptoms of pain or fatigue.
It is difficult to give advice about complementary treatments as response is often very different between different people and there is in general a lack of evidence for what helps. It is also important to note that people with chronic illness in general where treatment can be difficult, as is the case for many with FND, are vulnerable to claims from unscrupulous people who just want to make money by peddling miracle cures. However, I have had patients who have told me that they have got a lot of benefit from things like acupuncture, therapeutic massage and hypnosis. It is always a good idea to go on personal recommendation when seeing such practitioners.
Physiotherapy can also be useful, particularly for people with motor symptoms (e.g. weakness, muscle spasms, tremor). The treatment is based on the idea that the movement symptoms are caused by an abnormal learned pattern of movement that the brain has learned and therefore “retraining” may be able to replace this pattern with normal movement. Generic physiotherapy may not be that helpful for a lot of patients, but when done in a targeted way with a therapist with some understanding of FND it can be a very useful part of treatment.
Cognitive Behavioural Therapy (CBT) is the psychological therapy most commonly suggested for people with FND. As discussed above, I think it is important that this therapy is targeted to specific symptoms. CBT can be used in a rather generic way, so unless a patient is referred to someone with specific experience in treating FND, the therapist can tell the patient are unable to help as the person is not depressed or anxious. CBT can be of particular help for specific symptoms such as pain and non-epileptic attacks, when given in the right way. There are also other forms of psychological therapy that are available and are discussed in more detail in this section.
Sedative medications in general quite often reduce symptoms from FND (e.g. benzodiazepines, baclofen, opiates), but in my opinion the downside of these drugs are often very significant. This is particularly the case for pain, a very common accompaniment to FND, where I see many people on huge quantities of sedative medications like oral morphine, tramadol, codeine. These drugs do usually dull the pain to some extent, but they rarely reduce it significantly and in the long term the doses of the drugs have to escalate to get the same effect. This in turn leads to more side effects. In people where pain is a major component of symptoms I try to direct people towards good quality holistic pain management clinics where medications are used alongside pain specific physiotherapy and cognitive therapy.
Our Healthy FND Living sections provide many useful tools to manage functional symptoms. This section has been written by the spouse of one of our members. After collating member tips as well as drawing from her own experience of caring for her husband with FND, Lynn has gathered an extensive amount of self-help remedies. Of course even self-help tools should be discussed with your treating care provider before trying.