Functional Neurological Disorders. Neurology Service Hospital Ruber Internacional

Functional neurological disorders are a medical condition that is primarily due to an alteration in the functioning of the nervous system rather than to structural or degenerative damage to the nervous system, such as those commonly identified in other typical neurological diseases (e.g., stroke or multiple sclerosis). Historically, functional neurological disorders have been called by many names: conversive, psychosomatic, psychogenic or “medically unexplained”, and can cause problems with movement (tremor, gait disorders, dystonia, etc.), sensation, cognitive problems or episodes similar to those seen in epileptic seizures. These disorders can affect people of any age, including children and the elderly.

The diagnosis of functional neurological disorders is made positively, i.e., based on the clinical characteristics of the symptoms presented by the patients. The conventional complementary tests that are requested (MRI, electroencephalograms, electromyograms, etc) do not show alterations, but this does not mean that we reach the diagnosis by exclusion. Although classically, these disorders have been understood from a purely psychological point of view, nowadays it is known that psychological stressors are important risk factors that confer vulnerability to develop these disorders, but their presence is neither necessary nor sufficient for the diagnosis.

Visibility

Despite being the second leading cause of consultation in Neurology Services according to some studies, functional neurological disorders have insufficient public recognition (both in medical circles and among the general population), and in many cases they are disorders that are suffered from incomprehension and loneliness. It is important to note that these patients can have a disability and a deterioration in quality of life similar to that produced by other neurological diseases such as Parkinson’s disease or epilepsy. Since 2012, the International Day for Functional Neurological Disorders has been celebrated with the intention of supporting those affected and informing society about their existence in order to avoid the stigma that they often generate. In this sense, different patient associations have been created in recent years in other countries, and very recently in our country, as well as online resources to provide information to patients and families about these disorders.

Treatments and new developments

Functional neurological disorders lie at the interface between neurology and psychiatry, and provide the clearest example of the insufficiency of the dualistic view of mind and brain. The neuroscientific advances that have taken place in recent decades have clearly influenced the way these patients are diagnosed and treated. More and more is known about the biological, social and psychological factors that can act as predisposing, precipitating and perpetuating factors for symptoms. All this has generated a turning point in the attitude towards them and has evidenced the need to work as a team (family physicians, neurologists, psychiatrists, psychologists and physical rehabilitation teams) to row together with the patients and achieve the ultimate common goal: to improve the quality of life of these patients.