Functional Neurological Disorders

Plain-language definition

Real neurological symptoms without structural lesion. Neurofunctional rehabilitation is the first-line treatment.

Signs and points requiring attention

• Functional weakness or paralysis: typically affects a limb or one side of the body, with specific characteristics (positive Hoover's sign, give-way weakness). The patient is not faking: the symptom is real and disabling.
• Functional movement disorders: tremors, dystonia, myoclonus with distinctive characteristics (variability, distractibility, entrainment). Can be very disabling and require specific rehabilitation.
• Psychogenic non-epileptic seizures: episodes resembling epileptic seizures but without electroencephalographic correlate. Specific management different from epilepsy.
• Functional sensory disorders: numbness, pain, visual disorders without organic involvement. Often associated with motor disorders and contributing to overall disability.

• Appearance of new neurological symptoms: even if FND is diagnosed, new symptoms must be evaluated. An organic condition can coexist.
• Worsening despite well-conducted treatment: may require intensification of care, hospitalization in specialized unit, or diagnosis revision.
• Suicidal thoughts or major psychological distress: FND-related disability can be severe and depression risk is real. Urgent psychiatric referral if necessary.

Assessment and care

• Specialized neuromotor rehabilitation: motor relearning techniques using distraction and attention diversion, dual-task exercises, progressive reintegration of normal body schema.
• In-depth therapeutic education: diagnosis explanation (the brain is malfunctioning but not damaged), symptom validation, demystification, understanding of mechanisms. Crucial step for treatment adherence.
• Body awareness work: attentional focus exercises on movement, adapted mindfulness techniques, proprioceptive rehabilitation, mirror work.
• Progressive activity resumption: gradual re-exposure to triggering or avoided situations, concrete functional goals, deconditioning management, in coordination with psychological care.

This information does not replace diagnosis or medical consultation.