The unseen disorder in neurology: Functional Neurological Disorders (FND) - Frequency & Causes

Let us start this year understanding how frequent functional illnesses (FI) and FND are, so we recognize the magnitude of the problem that we are facing and trying to solve. Together with this topic, is also important to start gaining insight into the causes that unleash the appearance of these conditions. To achieve these goals, we will review some of the research that has taken place regarding occurrence and etiology.

It turns out that some studies describe FND being as common as multiple sclerosis (MS). In many retrospective revisions it has been reported that a total of 6% to 62% of the patients who go to the neurological offices for evaluation, after history and physical exam are classified as having “medically unexplained symptoms”, so it is believed that in many of these practices, the majority of patients have functional neurological symptoms or illnesses. Isn’t it unbelievable that despite FND being one of the commonest encountered conditions in neurology, is still so misunderstood, underdiagnosed, and poorly treated? How do you feel about this? Literally… what are your emotions when you read this evidence? Because only if we get in touch with our disappointment, we will be able to take the necessary steps to make the changes we want.

FND happens at a similar rate internationally, meaning that in most countries around the world, approximately the same number of people are affected, and in many clinics, the majority of patients that present to the neurologist have some manifestation of the illness.  FND is more common in women between 35 and 50 years old, and on the other hand, it affects men throughout their lifetime.

Despite this information being widely available, these disorders still often go under-recognized, and one of the reasons why this happens is because the clinical manifestations of the disorders follow a spectrum, ranging from some patients demonstrating very mild symptoms, or seldom events, perhaps two or three episodes or periods of illnesses during their lifetime, to others being chronically and severely ill, with many disabled individuals around the globe. So, there is tremendous variation in symptomatology, clinical appearances, and presentations. Another reason why FND is commonly underrecognized, is because we do not have an exam, test, or ancillary method readily available in clinical practice, to confirms the presence of the illness. Due to these circumstances, it is suspected that the frequency of the condition might be even higher than what I described above.

The consequences that derive from the current state of recognition, diagnosis and treatment are very serious. For example, in the U.S. alone the health care system spends $256 billion per year related to FND, due to the performance of many unnecessary tests, prescription of erroneous medications, procedures and surgeries. This financial strain in our country, is minimal compared to the physical, mental, and emotional suffering that takes place in these patients and their families.

Let us recap then: We are talking about perhaps the most common illness in neurology, which is poorly recognized, diagnosed and treated, and this in turn is draining our healthcare system, and leading to the performance of erroneous ancillary examinations and dangerous treatments, in some cases even leading to iatrogenic trauma, inflicted in an already ill population, by the very healthcare professionals that should be alleviating the problem. To me, as a neurologist, this feels unethical, extremely serious, insulting to my professional field, discordant with my Hippocratic oath, and tremendously distressing, so much so, that I could not take it anymore.

To really cure a disease, we must deeply comprehend its causes, and get to the root of the problem. We must then proceed now, with reviewing its etiology.

Why do these conditions happen? The reasons are many, dozens, or perhaps even hundreds, and they are all very personalized.

FND can appear after physical trauma, any injury in the body, and any disease in the body, for example Lyme’s disease, transient ischemic attack, syncope, or any other physical illness, and even after normal physiological events, such as after a moment of sleep paralysis. In some patients an injured leg can turn into limb paralysis or weakness. In other cases, shaking from fever can become constant tremor. Additional events, such as panic attacks, or undergoing general anesthesia can trigger some symptoms that may persist later. Many acute and chronic health problems can lead to the appearance of the disease, and even witnessing illnesses in friends and family members may give origin to it. It is interesting to mention that in many cases, the injury, the illness, or the problem that triggered the condition, was trivial from the perspective of the “severity” of an illness, so, even minor problems can trigger imbalances between our mind, emotions, and physical body that can persist in the form of FND if this phenomenon goes unnoticed by patients and healthcare professionals.

FND also happens often in patients who have structural problems in the nervous system, for example persons with multiple sclerosis, sciatic nerve problems, or neuropathy, may also develop functional symptoms. Organic and functional illnesses can, and often coexist.

FND is not only triggered by incidents that affect our physical health, but also by any personal or environmental situations that affects our nervous system, our minds, our emotions, our spirituality, or our life satisfaction, really, anything that causes strain and tension in our organism. For example, any changes in the circumstances of life, difficulties in interpersonal relationships, moving houses, shifting jobs, or any other stressors! And of course, more serious conditions such as adult or childhood trauma, that could be sexual, physical, or emotional abuse are also risk factors to later develop the disease.

And that is why it happens; because all and any of the situations above described could contribute to the appearance of imbalances between mind, body, emotions, and environment. Think about it this way; after any of those events our minds start viewing the world differently, there are a series of interpretations, thoughts and conclusions that take place. We also have certain emotional responses to those events, that may persist and become emotional memories in our nervous systems, and can even reappear later, when similar future situations happen. Randomly and for several reasons, we may also later experience certain physical sensations, and these can trigger our minds and emotions to subconsciously remind us of the original event or circumstance, making us feel certain “unexplained physical sensations or symptoms”.

The way how these etiologies or causes of FND turn into the disorder (the pathophysiological mechanisms) is a complex topic, that will be reviewed in detail with a later article and discussion. At that time, we will evaluate the various theories proposed in the medical literature.

Today I provided you with a quick summary of the frequency, epidemiology, and the causes of FND; some interesting and useful information that you can use to fuel your new beginning, your dawn, the new sunrise of your nervous system and your soul!

But tell me, what do you think about all these? What are your thoughts, your emotions, your own experience and what is your gut feeling, your body telling you? What is your story, and how has it unfolded for you? What does this mean to you? What could you do with this information?

This is what I propose:

• If you have been diagnosed with FND, but are not sure of the cause yet review your life, since you were in your mom’s wound until the moment you developed FND, and determine: What challenging events you went through? Physically, mentally, emotionally, or witnessed environmentally?

If you are not certain or do not recall, is important to talk to family members to investigate, because you need to understand your past and sometimes much of that knowledge is in the subconscious, sometimes we do not remember. It is vital then, to talk to others who are wise, attentive and can remind you, family members who can support you while you find out what happened. Let them support you while you walk the path of healing.

Regretfully, some of us do not have close family members to count on, and this is another reason why is useful to build a strong support network, also with friends, colleagues, similarly affected patients and health professionals who understand the condition, to exchange ideas, perspectives, and information, to help you go through this journey of healing and self-knowledge.

• Once you have an idea about what could have unleashed FND, reflect: How much emotional charge was involved in that event or series of events, what emotions are permeating those memories? All events have emotions associated to them; a fall from a bike may have felt upsetting, saddening, or frustrating, a surgery may have felt scary, etc.

• Also contemplate the possible consequences of those situations for your mind, and the meaning that you derived from the challenging, stressful, or traumatic situation, being it physical, emotional, mental, or environmental. What learnings, interpretations and meanings did you derive from those previous defiant events?

• How are those incidents or potential causes related to your physical body? Did you suffer a physical trauma or injury? Did you witness someone having physical damage or illness?

• If the triggers were emotional or mentally demanding situations, when you recall them, what do you notice in your body? Apprehension in your stomach? Sadness in your chest? Fear manifested with mild inner trembling?

• Regarding your environment, your activities, your personal and professional fulfillment, determine: What has been the role of stress and external demands in your life, during the past and even the present moment? How do you feel physically, emotionally, and mentally, living your life the way it is now?

As you can see, these are exercises that start bringing everything that permeates the human experience to your awareness: your mind, physical body, emotions and environment/spirituality. So, allow yourself time to investigate; understanding your past is important.

Consider also sharing what you discover with an empathetic, caring and compassionate person, because when you brainstorm together, when you speak up your perceptions, memories, and interpretations, you will open even wider the doors towards that great mystery which is understanding FND.

There is a reason why the cause of FND is so enigmatic, and that is because healthcare and wellness professional do not have access to your nervous system, your memories, your emotions, your physical sensations, and they do not understand your environment, your history and what you have gone through, as well as you have the potential to do it. Only you have that information, only you can retrieve it, and only you can find the true meaning of it all.

If you are curious about how the Holocene Method educational program works, and how it can fuel your path of self-healing and self-growth, let me know! We are only one click away, and I am always happy to learn from you all!

At your service,

Yadira Velazquez, MD

Functional illnesses healing ally