Functional Neurological Disorder (कार्यात्मक तंत्रिका संबंधी विकार)

Functional Neurological Disorder (FND)—also known as conversion disorder—presents with neurological symptoms such as weakness, tremors, or sensory changes without an identifiable structural lesion. Despite normal anatomy, patients experience genuine distress and disability. With over 11 years in neurology practice, I aim to explain FND’s features, evaluation, and management in clear, empathetic language.

What Is Functional Neurological Disorder?

FND arises from abnormal functioning of the nervous system rather than irreversible damage. Common presentations include:

Weakness or paralysis of a limb
Non-epileptic seizures or tremors
Sensory symptoms: numbness, tingling, or loss of vision
Gait disturbances: trembling or “astasia–abasia” (inability to stand)

For a comprehensive overview, see the NHS’s guide to functional neurological disorders.

Recognizing the Signs

Key features distinguishing FND from organic disease:

Sudden onset often following stress or injury
Inconsistency: Symptoms may vary with distraction or attention.
Entrainment: Tremor frequency changes when the patient performs a rhythmic task with another limb.
Hoover’s sign: Inconsistent leg weakness on formal testing versus involuntary movement.

How We Diagnose FND

Clinical Assessment: Detailed history exploring stressors, symptom patterns, and impact on daily life.
Neurological Examination: Identification of positive signs such as Hoover’s sign or incongruent gait.
Exclusion of Other Disorders: Basic MRI and nerve conduction studies rule out structural causes.
Rule-in Criteria: Emphasizing clinical features rather than exhaustive testing, per The Lancet’s diagnostic framework for FND.

Treatment Strategies

1. Education & Reassurance

Explaining that FND is a common and treatable condition helps reduce anxiety and stigma. Validating symptoms is crucial.

2. Physiotherapy & Occupational Therapy

Specialized Physiotherapy: Retraining movement using distraction techniques and graded exercises.
Occupational Therapy: Focus on functional tasks and adaptive strategies to restore independence.

3. Psychological Therapies

Cognitive Behavioral Therapy (CBT): Addresses maladaptive thoughts and behaviors that perpetuate symptoms.
Trauma-Focused Therapy: For patients with a history of psychological trauma, per guidelines from the British Psychological Society.

4. Multidisciplinary Rehabilitation

A coordinated team—including neurologists, psychiatrists, therapists, and social workers—ensures holistic care. Regular follow-up and goal-setting enhance progress.

Living Well with FND

Maintain a structured routine with balanced activity and rest.
Practice mind-body techniques such as mindfulness or gentle yoga to improve symptom control.
Engage in support groups to connect with others and share coping strategies.
Keep a symptom diary to identify triggers and track improvements.

When to Seek Help

If you experience sudden neurological symptoms without clear medical cause or notice inconsistency in your symptoms, an early specialist evaluation can lead to faster recovery and prevent chronic disability.

To schedule an evaluation or learn more:

—Dr. Rohit Anand
Consultant Neurologist, Jamshedpur