Functional neurologic disorders — a newer and broader term that includes what some people call conversion disorder — feature nervous system (neurological) symptoms that can't be explained by a neurological disease or other medical condition. However, the symptoms are real and cause significant distress or problems functioning.
Signs and symptoms vary, depending on the type of functional neurologic disorder, and may include specific patterns. Typically these disorders affect your movement or your senses, such as the ability to walk, swallow, see or hear. Symptoms can vary in severity and may come and go or be persistent. However, you can't intentionally produce or control your symptoms.
The cause of functional neurologic disorders is unknown. The condition may be triggered by a neurological disorder or by a reaction to stress or psychological or physical trauma, but that's not always the case. Functional neurologic disorders are related to how the brain functions, rather than damage to the brain's structure (such as from a stroke, multiple sclerosis, infection or injury).
Early diagnosis and treatment, especially education about the condition, can help with recovery.
Symptoms of functional neurologic disorders may vary, depending on the type of functional neurologic disorder, and they're significant enough to cause impairment and warrant medical evaluation. Symptoms can affect body movement and function and the senses.
Signs and symptoms that affect body movement and function may include:
Signs and symptoms that affect the senses may include:
Seek medical attention for signs and symptoms listed above. If the underlying cause is a neurological disease or another medical condition, quick diagnosis and treatment may be important. If the diagnosis is a functional neurologic disorder, treatment may improve the symptoms and help prevent future problems.
The exact cause of functional neurologic disorders is unknown. Theories regarding what happens in the brain to result in symptoms are complex and involve multiple mechanisms that may differ, depending on the type of functional neurologic disorder.
Basically, parts of the brain that control the functioning of your muscles and senses may be involved, even though no disease or abnormality exists.
Symptoms of functional neurologic disorders may appear suddenly after a stressful event, or with emotional or physical trauma. Other triggers may include changes or disruptions in how the brain functions at the structural, cellular or metabolic level. But the trigger for symptoms can't always be identified.
Factors that may increase your risk of functional neurologic disorders include:
Women may be more likely than men to develop functional neurologic disorders.
Some symptoms of functional neurologic disorders, particularly if not treated, can result in substantial disability and poor quality of life, similar to that caused by medical conditions or disease.
There are no standard tests for functional neurologic disorders. Diagnosis usually involves assessment of existing symptoms and ruling out any neurological or other medical condition that could cause the symptoms.
Functional neurologic disorders are diagnosed based on what is present, such as specific patterns of signs and symptoms, and not just by what is absent, such as a lack of structural changes on an MRI or abnormalities on an EEG.
Testing and diagnosis usually involves a neurologist, but may include a psychiatrist or other mental health professional. Your doctor may use any of these terms: functional neurologic disorders (FNDs), functional neurological symptom disorder or conversion disorder.
One advantage to using the term "functional neurologic disorders" is that it can be used to specify the type of functional neurological symptoms you have. For example, if your symptoms include problems walking, your doctor may refer to functional gait disorder or functional weakness.
Evaluation may include:
DSM-5 lists these criteria for conversion disorder (functional neurological symptom disorder):
Treatment will depend on your type of functional neurologic disorder and your particular signs and symptoms. For some people, a multispecialty team approach that includes a neurologist; psychiatrist or other mental health professional; speech, physical and occupational therapists; or others may be appropriate.
Understanding what functional neurologic disorders are, that the symptoms are real and that improvement is possible can help you with treatment choices and recovery. Symptoms may get better after an explanation of the condition and reassurance from your doctor that symptoms aren't caused by a serious underlying neurological or medical problem.
For some people, education and reassurance that they don't have a serious medical problem is the most effective treatment. For others, additional treatments may be beneficial. Involving loved ones can be helpful so that they can understand and support you.
Your medical team provides treatment of any medical or neurological disease you may have that might be a trigger for your symptoms.
Depending on your needs, therapies may include:
Even though functional neurological symptoms are not "all in your head," emotions and the way you think about things can have an impact on your symptoms and your recovery. Psychiatric treatment options may include:
Medications are not effective for functional neurologic disorders, and no drugs are approved by the Food and Drug Administration specifically as a treatment. However, medications such as antidepressants may be helpful if you also have depression or other mood disorders, or you're having pain or insomnia.
Regular follow-up with your medical team is important to monitor your recovery and make changes to your treatment plan as needed.
You may start by seeing your primary care doctor. He or she may refer you to a neurologist. You may want to take a family member or friend along, if possible, to help you remember information and for support.
To prepare for your appointment, make a list of:
Some questions to ask your doctor include:
Don't hesitate to ask other questions during your appointment.
Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask: