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Functional neurological disorder: new subtypes and shared mechanisms.

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Functional neurological disorder (FND) diagnosis involves identifying variable symptom patterns. This condition, encompassing functional seizures and movement disorders, benefits from multidisciplinary treatment.

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Area of Science:

  • Neurology
  • Psychiatry
  • Neuroscience

Background:

  • Functional neurological disorder (FND) is prevalent in neurological practice.
  • FND presents with diverse symptoms and signs, often linked to psychological stressors, though these are not always present.
  • Four distinct entities—functional seizures, functional movement disorders, persistent perceptual postural dizziness, and functional cognitive disorder—are recognized as variants of FND.

Purpose of the Study:

  • To present a novel approach for the positive diagnosis of functional neurological disorder.
  • To highlight the shared etiology and pathophysiology among the four main FND variants.
  • To underscore the importance of recognizing distinctive features and diagnostic support through neurophysiology and biomarkers.

Main Methods:

  • Focusing on recognizable patterns of genuinely experienced symptoms and signs.
  • Observing symptom and sign variability within tasks and over time.
  • Utilizing clinical neurophysiological studies and other biomarkers for diagnosis.

Main Results:

  • A new diagnostic approach identifies specific patterns of genuine symptoms and signs with variability.
  • Functional seizures, movement disorders, dizziness, and cognitive disorders share etiological and pathophysiological similarities.
  • Distinctive features of each FND variant can be diagnosed using neurophysiological studies and biomarkers.

Conclusions:

  • Functional neurological disorder is a complex condition at the interface of neurology and psychiatry.
  • Diagnosis relies on identifying characteristic symptom patterns and utilizing objective biomarkers.
  • Tailored, multidisciplinary treatment, including physical and psychological therapies, is supported by evidence.