Functional neurologic disorder/conversion disorder

There are no standard tests for functional neurologic disorder. Diagnosis usually involves assessment of existing symptoms and ruling out any neurological or other medical condition that could cause the symptoms.

Functional neurologic disorder is 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 health care provider may use any of these terms: functional neurologic disorder (FND), functional neurological symptom disorder or an older term called conversion disorder.

Sometimes your disorder may be called by a term that specifies the type of functional neurological symptoms you have. For example, if your symptoms include problems walking, your health care provider may call it functional gait disorder or functional weakness.

Evaluation may include:

• Physical exam. Your health care provider examines you and asks in-depth questions about your health and your signs and symptoms. Certain tests may eliminate neurological disease or other medical disorders as the cause of your symptoms. Which tests you'll have depends on your signs and symptoms.
• Psychiatric exam. If appropriate, your neurologist may refer you to a mental health professional. He or she asks questions about your thoughts, feelings and behavior and discusses your symptoms. With your permission, information from family members or others may be helpful.
• Diagnostic criteria in the DSM-5. Your health care provider may compare your symptoms to the criteria for diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists these criteria for conversion disorder (functional neurological symptom disorder):

• One or more symptoms that affect body movement or your senses
• Symptoms can't be explained by a neurological or other medical condition or another mental health disorder
• Symptoms cause significant distress or problems in social, work or other areas, or they're significant enough that medical evaluation is recommended

Treatment for functional neurologic disorder will depend on 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.

Learning about functional neurologic disorder

Understanding what functional neurologic disorder is, 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 health care provider that symptoms are not caused by a serious underlying neurological or other medical disorder.

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.

Medical disorder treatment

Your medical team provides treatment of any underlying neurological or other medical disease you may have that might be a trigger for your symptoms.

Therapies

Depending on your needs, therapies may include:

• Physical or occupational therapy. Working with a physical or occupational therapist may improve movement symptoms and prevent complications. For example, regular movement of arms or legs may ward off muscle tightness and weakness if you have paralysis or loss of mobility. Gradual increases in exercise may improve your ability to function.
• Speech therapy. If your symptoms include problems with speech or swallowing, working with a speech therapist (speech-language pathologist) may help.
• Stress reduction or distraction techniques. Stress reduction techniques can include methods such as progressive muscle relaxation, breathing exercises, physical activity and exercise. Distraction techniques can include music, talking to another person, or deliberately changing the way you walk or move.

Mental health options

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:

• Cognitive behavioral therapy (CBT). A type of psychotherapy, cognitive behavioral therapy (CBT) helps you become aware of inaccurate or negative thinking so that you can view situations more clearly and respond to them in a more effective way. can also help you learn how to better manage stressful life situations and symptoms. This may be particularly beneficial if your symptoms include nonepileptic seizures. Other types of psychotherapy may be helpful if you have interpersonal problems or a history of trauma or abuse.
• Treating other mental health conditions. Anxiety, depression or other mental health disorders can worsen symptoms of functional neurologic disorder. Treating mental health conditions along with functional neurologic disorder can help recovery.

Medications

Medications are not effective for functional neurologic disorder, 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

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 provider. 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.

What you can do

To prepare for your appointment, make a list of:

• Any symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment
• Key personal, family and social information, including any major stresses or recent life changes
• All medications, vitamins, herbs or other supplements you're taking, and the dosages
• Questions to ask your health care provider

Some questions to ask your health care provider include:

• What is likely causing my symptoms or condition?
• Are there other possible causes?
• What kinds of tests do I need?
• What treatment approach do you recommend?
• For how long will I need to be treated?
• What can I do to reduce the risk of my symptoms recurring?
• Should I see a specialist?
• If I need to take medications, what are the main side effects?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your health care provider 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 health care provider may ask:

• What are your symptoms?
• When did you first notice these symptoms?
• How have your symptoms changed over time?
• How do your symptoms impact your ability to function?
• What do you think may be causing your symptoms?
• Have you been diagnosed with any other medical conditions or mental health problems?
• Do you use alcohol or recreational drugs? How often?

Your health care provider will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.