Functional Neurological Disorder
NORD gratefully acknowledges Jon Stone MB, ChB, PhD, Consultant Neurologist, Co-director Functional Disorders Research Group, University of Edinburgh, UK; Tim Nicholson, Honorary Consultant Neuropsychiatrist, South London & Maudsley NHS Foundation Trust and Kings College Hospital NHS Foundation Trust, London, Clinical Senior Lecturer in the Section of Cognitive Neuropsychiatry, Institute of Psychiatry Psychology & Neuroscience, King’s College London; and Bridget Mildon, President/CEO FND Hope, Inc., for the preparation of this report.
Synonyms of Functional Neurological Disorder
functional neurological symptom disorder
functional movement disorder
psychogenic seizures / movement disorder
dissociative seizures / motor disorder
Functional neurological disorder (FND) is a medical condition in which there is a problem with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process such as multiple sclerosis or stroke. FND can encompass a wide variety of neurological symptoms, such as limb weakness or seizures.
FND is a condition at the interface between the specialties of neurology and psychiatry. Conventional tests such as MRI brain scans and EEGs are usually normal in patients with FND. This had led, historically, to the condition being relatively neglected by both clinicians and researchers. However, it is now established that FND is a common cause of disability and distress, which may overlap with other problems such as chronic pain and fatigue. Encouraging studies support the potential reversibility of FND with specifically tailored treatments. New scientific findings are influencing how patients are diagnosed and treated which is creating an overall change in attitude towards people with FND.
Older ideas that FND is “all psychological” and that the diagnosis is made only when someone has normal tests have changed since the mid-2000s. The new understanding, including modern neuroscientific studies, has shown that FND is not a diagnosis of exclusion. It has specific clinical features of its own and is a disorder of the nervous system functioning in which many perspectives are necessary. These vary a lot from person to person. In some people, psychological factors are important, in others they are not.
Signs & Symptoms
FND patients can experience a wide range and combination of symptoms that are physical, sensory and/or cognitive. The most common include:
• Functional limb weakness/paralysis
• Functional movement disorders; including tremor, spasms (dystonia), jerky movements (myoclonus) and problems walking (gait disorder)
• Functional speech symptoms; including whispering speech (dysphonia), slurred or stuttering speech
• Functional sensory disturbance includes altered sensation; e.g. numbness, tingling or pain in the face, torso or limbs. This often occurs on one side of the body
• Functional visual symptoms; including loss of vision or double vision
Episodes of altered awareness
• Dissociative (non-epileptic) seizures, blackouts and faints: these symptoms can overlap and can look like epileptic seizures or faints (syncope)
Symptoms often fluctuate and may vary from day to day or be present all the time. Some patients with FND may experience substantial or even complete remission followed by sudden relapses of symptoms.
Other physical and psychological symptoms are commonly experienced by patients with FND but may not be present. These include: chronic pains, fatigue, sleep problems, memory symptoms, bowel and bladder symptoms, anxiety and depression.
The exact cause of FND is unknown, although ongoing research is starting to provide suggestions as to how and why it develops. Many different predisposing factors can make patients more susceptible to FND such as having another neurological condition, experiencing chronic pain, fatigue or stress. However, some people with FND have none of these risk factors.
At the time FND begins, studies have shown that there may be triggering factors like a physical injury, infectious illness, panic attack or migraine which can give someone the first experience of the symptoms. These symptoms normally settle down on their own. However, in FND the symptoms become ‘stuck’ in a ‘pattern’ in the nervous system. That ‘pattern’ is reflected in altered brain functioning. The result is a genuine and disabling problem, which the patient cannot control. The aim of treatment is to ‘retrain the brain’, for example by unlearning abnormal and dysfunctional movement patterns that have developed and relearning normal movement.
One way of thinking about FND is looking at it as a bit like a ‘software’ problem on a computer. The ‘hardware’ is not damaged but there is a problem with the ‘software’ and so the computer doesn’t work doesn’t work properly. Conventional structural MRI brain scans are usually normal in FND unless the person has another neurological condition. Functional’ brain scans (fMRI) are starting to provide early evidence for how the brain goes wrong in FND. fMRI scans show changes in patients with FND which look different from healthy patients without these symptoms as well as healthy people ‘pretending’ to have these symptoms. Functional imaging is still a research tool and is not developed enough to be used in the diagnosis of FND. Scans support what patients and researchers already know – these are genuine disorders in which there is a change in brain functioning, which is out with the control of the person with FND.
Historically, FND has traditionally been viewed as an entirely psychological disorder in which repressed psychological stress or trauma gets ‘converted’ into a physical symptom. This is where the term ‘conversion disorder’ comes from. Psychological disorders and stressful life events, both recent and in childhood, may be risk factors for developing the condition in some patients, but they rarely provide a full explanation for the cause of the condition and are absent in many patients. Patients do not have to be depressed, anxious or the survivor of adverse childhood experience to develop FND.
Modern theories propose that FND has many causes, which vary from patient to patient. One comparison is to think about heart disease. There are lots of causes of heart disease – smoking, genetic factors, diet and even stress-related / psychological factors such as depression. Smoking may be a factor in heart disease in many people, but it is not in everyone. The same analogy can be made for FND. In some psychological factors such as past trauma or stress at the time of symptom onset in FND are important in understanding how the brain has gone wrong. In others the presence of a problem like migraine or a physical injury may be the most important thing.
The exact prevalence of FND is unknown. However, research suggests FND is the second most common reason for a neurological outpatient visit after headache/migraine; accounting for one sixth of diagnoses. This means FND is as common as multiple sclerosis or Parkinson’s disease.
FND can affect anyone, at any time, although it is uncommon in children under 10. FND is more likely to affect women than men for most symptoms, although when patients present over the age of 50 then it occurs equally in both groups.
It is common for FND to co-exist with other illnesses. FND can have similar symptoms to most other types of condition seen in neurological practice such as multiple sclerosis, stroke and epilepsy. Some patients have both a neurological disease diagnosis such as stroke and FND. A neurologist is normally required to assess which symptoms relate to FND and to monitor where required for any new symptoms.
Anxiety and depression can sometimes cause physical symptoms which overlap with FND symptoms. For example, panic attacks can present with symptoms such as pins and needles in the fingers or mouth and depression often causes poor concentration or fatigue. Anxiety and depression are common in patients with FND but many patients do not have such problems.
Chronic pain is also common in patients with FND including fibromyalgia, which is also related to disturbed nervous system functioning. Pain disorders are also usually associated with fatigue, sleep disturbance, and poor concentration. Migraine and chronic headaches are also common.
Other functional disorders including irritable bowel syndrome, or overactive bladder syndrome are more common in patients with FND.
It is important that new symptoms not automatically be considered functional and other causes are considered and investigated as appropriate.
FND is diagnosed on the basis of positive physical signs, and usually requires a neurologist or a doctor familiar with neurological diagnosis. Some examples of these signs are:
• Hoover’s test is for of functional leg weakness – the patient may have difficulty pushing their “bad” leg down (hip extension), but when they are asked to lift up their “good” leg, movement in the “bad” leg returns transiently to normal.
• The tremor entrainment test for functional tremor – this is when the shaking of an arm or leg becomes momentarily better when the person concentrates on copying a movement that the examiner makes.
• Dissociative (non-epileptic) seizures can often be recognised by a trained health professional using a combination of typical features such as: an episode of violent limb thrashing in which the eyes remain closed, side-to-side head movements, or an event lasting longer than 5 minutes where the eyes are closed, hyperventilation during a shaking attack or tearfulness on recovery.
FND can be hard to understand and most people haven’t heard of it. Treatment should start with a clear and supportive explanation of the positive clinical features that have allowed the diagnosis to be made, even though scans and other laboratory tests may be normal.
When it goes well, understanding the diagnosis enables the patient to see that they have a genuine and relatively common condition which has the potential for improvement over time. This creates a foundation for treatment to build upon. Written information, like that available at www.neurosymptoms.org or www.fndhope.org may help individuals comprehend this complex and difficult to understand disorder.
Evidence is now emerging for the efficacy of certain treatments, especially physiotherapy for motor symptoms and a type of psychological therapy called cognitive behavioral therapy (CBT) for attacks or seizures. Specialized types of physiotherapy and CBT have been developed for FND. Other therapies such as speech therapy and occupational therapy may also have a role depending on the symptoms.
For patients with motor symptoms such as limb weakness, gait problems or movement disorder, physical therapy from a therapist who understands something of FND can be helpful. Physiotherapy approaches are active treatments that focus on retraining movement patterns that have gone wrong. There is some evidence from clinical trials that physiotherapy designed specifically for FND can be helpful for some patients. In recent years we have learned that physical therapy for FND is different from that used for stroke or MS in many ways. For example, patients with stroke benefit from being asked to focus on the affected body part, whereas in FND that tends to make things worse. Physical therapy for FND promotes ‘automatic movements’ and reduces the abnormal brain patterns that have been interfering with movement.
CBT is generally the first line of treatment for patients with dissociative (non-epileptic) seizures or attacks as part of their FND and is supported by clinical trials. Therapy includes time to learn more about their attacks and recognizing brief warning symptoms and learning techniques to regain control. For some patients it is helpful to look more widely at thoughts, emotions, and experiences that could have played a role in the development of symptoms. For those patients without anxiety and depression, psychological therapy may still be useful in regaining confidence. FND itself is often experienced as a stressful condition to manage and live with. Other types of psychological therapies can also be used depending on the individual patient, e.g. psychodynamic interpersonal therapy (PIT) or more trauma-focused work for patients who have had such experiences.
Occupational Therapy assists patients in finding adaptations and regaining confidence in their ability to carry out daily activities in the home or workplace. Occupational therapy can help build on other therapies to contribute to a better overall quality of life.
For patients with speech symptoms as part of FND, speech therapy is an important part of treatment. Like physical therapy, the approach is different from that used, for example, after a stroke and patients benefit from seeing therapists confident in this area.
There is no research-based evidence that any specific medication is beneficial for FND, but medications may be useful for other symptoms commonly occurring with FND such as pain, migraine or anxiety. Other therapies are being investigated in research studies
Not everyone with FND can benefit from treatment even if they do understand their condition and are well motivated.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Some current clinical trials also are posted on the following page on the NORD website:
For information about clinical trials sponsored by private sources, contact:
For information about clinical trials conducted in Europe, contact:
PO Box 8126
Gaithersburg, MD 20898-8126
Phone: (301) 251-4925
Toll-free: (888) 205-2311
Page content and reference material is the property of https://rarediseases.org/rare-diseases/fnd/
reproduced for patient information purposes with thanks
Hallett M, Stone J, Carson A (eds. . Functional Neurologic Disorders: Handbook of Clinical Neurology (Volume 139). Amsterdam: Elsevier 2016.
Schacter S, LaFrance Jr WC. Gates and Rowan’s Nonepileptic Seizures – 3rd Edition. Cambridge: Cambridge University Press 2010.
Nielsen G, Buszewicz M, Stevenson F, et al. Randomised feasibility study of physiotherapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatry 2017;88:484–90.
Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures (PNES). Clin Psychol Rev. 2016;47:55–70.
Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry 2015;86:1113–9.
Jordbru AA, Smedstad LM, Klungsøyr O, et al. Psychogenic gait disorder: A randomized controlled trial of physical rehabilitation with one-year follow-up. J Rehabil Med. 2014;46:181–7.
Edwards M, Bhatia K. Functional (psychogenic) movement disorders: merging mind and brain. Lancet Neurol. 2012;11:250–60.
Goldstein LH, Chalder T, Chigwedere C, et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology 2010;74:1986–94.
Functional and Dissociative Neurological Symptoms: a patient’s guide.
Free website with self-help information about all aspects of FND.
Written by Dr. Jon Stone, Neurologist, Edinburgh, UK http://www.neurosymptoms.org/
Accessed March 14, 2018.
Non-Epileptic Attacks. Free website with self-help information about dissociative (non-epileptic) attacks. Written by Prof. Markus Reuber, Neurologist, Sheffield, UK http://www.nonepilepticattacks.info/ Accessed March 14, 2018.
"Nord, kwa shukrani, inashukuru Jon Stone, MD, PhD, Mshauri wa Neurolojia, Mkurugenzi Mshirika wa Kikundi cha Utafiti wa Matatizo ya Kazi, Chuo Kikuu cha Edinburgh, Uingereza; Tim Nicholson, Mshauri wa Heshima wa Neuropsychiatrist, NHS Foundation Trust ya Kusini mwa London na Maudsley na King's College Hospital Foundation Trust, London, Mhadhiri Mkuu wa Kliniki katika Idara ya Neuropsychiatry ya Ujuzi, Taasisi ya King's College London; na Bridget Mildon, Rais na Mkurugenzi Mtendaji wa NHS. """ Functional Neurological Disorder (FND) ni ugonjwa wa mfumo wa neva ambao ni tatizo la utendaji wa mfumo wa neva na jinsi ubongo na mwili hutuma na kupokea ishara badala ya mchakato wa ugonjwa wa muundo kama vile multiple sclerosis au kiharusi. Ugonjwa wa FND unaweza kujumuisha dalili mbalimbali za neva, kama vile udhaifu wa viungo au mshtuko wa akili. FND ni hali katika interface kati ya utaalam wa neurology na psychiatry. Uchunguzi wa kawaida kama vile MRI ya ubongo na EEG ni kawaida kwa wagonjwa wenye FND. Hii ilikuwa imesababisha, kihistoria, hali hiyo kupuuzwa kwa kiasi na madaktari na watafiti. Hata hivyo, sasa imethibitishwa kwamba FND ni sababu ya kawaida ya ulemavu na shida, ambayo inaweza kuingiliana na matatizo mengine kama vile maumivu ya muda mrefu na uchovu. Uchunguzi unaohamasisha unasaidia uwezekano wa kubadilika kwa FND na matibabu yaliyoboreshwa haswa. Utafiti mpya wa kisayansi unaathiri jinsi wagonjwa wanavyogunduliwa na kutibiwa, na hivyo kuunda mabadiliko ya jumla katika mtazamo wa watu wanaopitia ugonjwa wa FMS. Maoni ya zamani kwamba FND ni "saikolojia yote" na kwamba utambuzi hufanywa tu wakati mtu ana vipimo vya kawaida vimebadilika tangu katikati ya miaka ya 2000. Utafiti wa hivi karibuni wa neuroscience unaonyesha kwamba ugonjwa wa FGM haujatambuliwa kama ugonjwa wa kutengwa. Ina sifa maalum za kliniki na ni ugonjwa wa mfumo wa neva ambao unahitaji mtazamo mbalimbali. Hizi hutofautiana sana kutoka mtu mmoja hadi mwingine. Kwa watu fulani, mambo ya kisaikolojia ni muhimu, lakini kwa wengine si muhimu. Kwa sababu ya dalili za ugonjwa wa FWD, wagonjwa wanaweza kupata dalili mbalimbali za kimwili, hisia na utambuzi. • Udhaifu wa utendaji wa viungo vya mwili (paralysis) • Matatizo ya utendaji wa harakati (kujumuisha kutetemeka, spasms (dystonia), miili ya myoclonus) na matatizo ya kutembea (matatizo ya kutembea) • Dalili za utendaji wa hotuba (kujumuisha usemi wa kunong'oneza (dysphonia), usemi wa kusisitiza au kukohoa) • Matatizo ya utendaji wa hisia (kujumuisha hisia zilizobadilishwa) Ugonjwa wa kutojua, kuugua au maumivu katika uso, mwili au viungo. • Madhara ya kuona: dalili za kuona; pamoja na kupoteza maono au maono mawili; vipindi vya ufahamu uliobadilishwa; mshtuko wa akili (si wa kifafa), kukosa fahamu na kukosa fahamu: dalili hizi zinaweza kuingiliana na zinaweza kuonekana kama mshtuko wa kifafa au kukosa fahamu (syncope); dalili mara nyingi hubadilika na zinaweza kutofautiana kutoka siku hadi siku au kuwapo wakati wote. Baadhi ya wagonjwa wenye FND wanaweza kupata uponyaji mkubwa au hata kamili uliofuatiwa na kurudia ghafla kwa dalili. Dalili nyingine za kimwili na kisaikolojia ni kawaida uzoefu na wagonjwa na FND lakini inaweza kuwapo. Hizi ni pamoja na: maumivu ya kudumu, uchovu, matatizo ya usingizi, dalili za kumbukumbu, dalili za matumbo na kibofu cha mkojo, wasiwasi na unyogovu. Sababu halisi ya ugonjwa wa F.N.D. haijulikani, ingawa utafiti unaoendelea unaanza kutoa mapendekezo kuhusu jinsi na kwa nini unatokea. Kuna sababu nyingi zinazoweza kuwafanya wagonjwa wawe na uwezekano mkubwa wa kupata ugonjwa wa FMS, kama vile kuwa na hali nyingine ya neva, maumivu ya kudumu, uchovu au mkazo. Hata hivyo, watu wengine walio na ugonjwa huo hawana sababu zozote za hatari. Wakati FTD huanza, masomo yameonyesha kuwa kunaweza kuwa na sababu za kuchochea kama majeraha ya kimwili, ugonjwa wa kuambukiza, shambulio la hofu au kipandauso ambayo inaweza kumpa mtu uzoefu wa kwanza wa dalili. Kwa kawaida dalili hizo hutoweka zenyewe. Hata hivyo, katika FND dalili kuwa "kufungwa" katika "muundo" katika mfumo wa neva. "Mfano" huo huonyeshwa katika utendaji wa ubongo uliobadilika. Matokeo ni tatizo halisi na lenye kulemaza, ambalo mgonjwa hawezi kulidhibiti. Lengo la matibabu ni "kuzoeza upya ubongo", kwa mfano kwa kuondoa mifumo ya harakati isiyo ya kawaida na isiyo ya kazi ambayo imesitawi na kujifunza tena harakati ya kawaida. Njia moja ya kufikiri kuhusu FND ni kuangalia ni kama kidogo kama "programu" tatizo kwenye kompyuta. "Hardware" si kuharibiwa lakini kuna tatizo na "programu" na hivyo kompyuta haina kazi haina kazi vizuri. Utafiti wa ubongo wa MRI ya kawaida ni kawaida katika FND isipokuwa mtu ana hali nyingine ya neva. Uchunguzi wa ubongo wa kazi (fMRI) unaanza kutoa ushahidi wa mapema wa jinsi ubongo unavyofanya makosa katika FND. Uchunguzi wa fMRI unaonyesha mabadiliko katika wagonjwa wenye FND ambayo yanaonekana tofauti na wagonjwa wenye afya bila dalili hizi na pia watu wenye afya "wanajifanya" kuwa na dalili hizi. Functional imaging bado ni chombo cha utafiti na haijaendelezwa vya kutosha kutumiwa katika utambuzi wa FND. Uchunguzi wa uchunguzi wa ubongo unaonyesha kwamba wagonjwa na watafiti wanajua kuwa kuna mabadiliko katika utendaji wa ubongo, ambayo ni nje ya udhibiti wa mtu mwenye ugonjwa wa ubongo. Kihistoria, FND imekuwa ikionekana kama ugonjwa wa kisaikolojia ambapo mkazo wa kisaikolojia au majeraha ya kukandamizwa "hupatikana" kuwa dalili ya kimwili. Hii ni ambapo neno "kugeuka ugonjwa" linatokana. Matatizo ya kisaikolojia na matukio ya maisha ya mkazo, ya hivi karibuni na ya utotoni, yanaweza kuwa sababu za hatari ya kuendeleza hali hii kwa baadhi ya wagonjwa, lakini mara chache hutoa ufafanuzi kamili wa sababu ya hali hiyo na haipo kwa wagonjwa wengi. Ni muhimu kujua kwamba mtu hawezi kuwa na wasiwasi, kushuka moyo au kuwa na uzoefu mbaya wa utotoni ili kuendeleza ugonjwa wa FAD. Nadharia za kisasa zinadokeza kwamba FND ina visababishi vingi, ambavyo hutofautiana kutoka kwa mgonjwa hadi mgonjwa. Ulinganisho mmoja ni kufikiria ugonjwa wa moyo. Kuna sababu nyingi za ugonjwa wa moyo - uvutaji sigara, sababu za maumbile, lishe na hata sababu za kisaikolojia zinazohusiana na mkazo kama vile mshuko wa moyo. Kuvuta sigareti kunaweza kusababisha ugonjwa wa moyo kwa watu wengi, lakini si kwa kila mtu. Mfano huo huo unaweza kufanywa kwa FND. Kwa sababu ya hali ya kisaikolojia, kama vile majeraha ya zamani au mkazo wakati wa mwanzo wa dalili, Fandom ni muhimu katika kuelewa jinsi ubongo umeenda vibaya. Kwa wengine, ikiwa kuna tatizo kama kipandauso au jeraha la kimwili, huenda ikawa jambo la maana zaidi. Ugonjwa wa FND haujulikani kwa usahihi. Hata hivyo, utafiti unaonyesha kwamba ugonjwa wa kichwa ni sababu ya pili ya kawaida ya kutembelea wagonjwa wa nje wa neva baada ya maumivu ya kichwa na kipandauso, na ni moja ya sita ya wagonjwa wote. Hii inamaanisha FND ni ya kawaida kama multiple sclerosis au ugonjwa wa Parkinson. Ugonjwa wa FWD unaweza kuathiri mtu yeyote, wakati wowote, ingawa ni nadra kwa watoto chini ya miaka 10. Ugonjwa huu unaathiri zaidi wanawake kuliko wanaume, ingawa kwa wagonjwa walio na umri wa zaidi ya miaka 50, huonekana sawa katika vikundi vyote viwili. Ni kawaida kwa FND kuishi pamoja na magonjwa mengine. Ugonjwa wa FMD unaweza kuwa na dalili sawa na aina nyingine za hali inayoonekana katika mazoezi ya neva kama vile multiple sclerosis, kiharusi na kifafa. Baadhi ya wagonjwa wana utambuzi wa ugonjwa wa neva kama vile kiharusi na FND. Kwa kawaida, mtaalamu wa neva anahitaji kuchunguza dalili zinazohusiana na FND na kufuatilia ikiwa inahitajika kwa dalili mpya. Wakati mwingine wasiwasi na unyogovu unaweza kusababisha dalili za kimwili ambazo huingiliana na dalili za FND. Kwa mfano, mashambulizi ya hofu yanaweza kuonekana na dalili kama vile pini na sindano katika vidole au mdomo, na mara nyingi unyogovu husababisha usikivu mbaya au uchovu. Maumivu na kushuka moyo ni kawaida kwa wagonjwa wenye FND lakini wagonjwa wengi hawana matatizo kama hayo. Maumivu ya muda mrefu ni ya kawaida kwa wagonjwa wenye FMD, ikiwa ni pamoja na fibromyalgia, ambayo pia inahusiana na utendaji wa mfumo wa neva uliovurugika. Kwa kawaida matatizo ya maumivu huhusianishwa pia na uchovu, matatizo ya usingizi, na kukosa kukaza fikira. Migraine na maumivu ya kichwa ya kudumu ni mambo ya kawaida pia. Matatizo mengine ya kazi ikiwa ni pamoja na ugonjwa wa matumbo yenye kukasirika, au ugonjwa wa kibofu cha mkojo wenye shughuli nyingi ni ya kawaida zaidi kwa wagonjwa wenye FND. Ni muhimu kwamba dalili mpya hazionekani moja kwa moja kuwa kazi na sababu nyingine zinafikiriwa na kuchunguzwa kama inavyostahili. Ugonjwa wa FTD unagunduliwa kwa msingi wa dalili za kimwili, na kwa kawaida inahitaji daktari wa neva au daktari anayejua utambuzi wa neva. Mtihani wa Hoover ni kwa ajili ya udhaifu wa kazi ya mguu - mgonjwa anaweza kuwa na ugumu wa kusukuma mguu wao mbaya chini (upanuzi wa kiuno), lakini wanapokuwa wameulizwa kuinua mguu wao mzuri, harakati katika mguu mbaya hurudi kwa kawaida. Mtihani wa kuingilia kwa tetemeko la mwili kwa tetemeko la kazi ni wakati kutetemeka kwa mkono au mguu kunapokuwa bora kwa muda wakati mtu anajishughulisha na kunakili mwendo ambao mtihani hufanya. Mara nyingi, mshtuko wa kifafa (si wa kifafa) unaweza kutambuliwa na mtaalamu wa afya aliyefundishwa kwa kutumia mchanganyiko wa sifa za kawaida kama vile: kipindi cha kushambulia kwa nguvu kwa viungo ambavyo macho yanaendelea kufungwa, mwendo wa kichwa upande mmoja, au tukio la zaidi ya dakika 5 ambapo macho yamefungwa, hyperventilation wakati wa shaking au tearfulness wakati wa kupona. FND inaweza kuwa ngumu kuelewa na watu wengi hawajawahi kusikia kuhusu hilo. Matibabu yanapaswa kuanza na ufafanuzi wa wazi na wa kuunga mkono wa sifa nzuri za kliniki ambazo zimeruhusu utambuzi kufanywa, hata ingawa uchunguzi na vipimo vingine vya maabara vinaweza kuwa kawaida. Wakati inakwenda vizuri, kuelewa utambuzi huwezesha mgonjwa kuona kwamba wana hali halisi na ya kawaida ambayo ina uwezo wa kuboresha kwa muda. Hilo hufanyiza msingi wa matibabu ya kujenga juu yake. Maelezo yaliyoandikwa, kama yale yanayopatikana kwenye www.neurosymptoms.org au www.fndhope.org, yanaweza kuwasaidia watu kuelewa ugonjwa huu tata na mgumu kuelewa. Kuna ushahidi unaoibuka sasa wa ufanisi wa matibabu fulani, hasa tiba ya mwili kwa dalili za magari na aina ya tiba ya kisaikolojia inayoitwa tiba ya tabia ya utambuzi (CBT) kwa mashambulizi au mashambulizi. Aina maalum za tiba ya mwili na CBT zimetengenezwa kwa FND. Matibabu mengine kama vile tiba ya hotuba na tiba ya kazi yaweza pia kuwa na jukumu kulingana na dalili. Kwa wagonjwa wenye dalili za magari kama vile udhaifu wa viungo, matatizo ya kutembea au matatizo ya harakati, tiba ya kimwili kutoka kwa mtaalamu wa matibabu ambaye anaelewa kitu cha FND inaweza kuwa na msaada. Mbinu za tiba ya mwili ni matibabu yenye bidii ambayo hukazia kurekebisha mifumo ya mwendo ambayo imekosa kufanya kazi. Kuna ushahidi kutoka kwa majaribio ya kliniki kwamba physiotherapy iliyoundwa maalum kwa FND inaweza kuwa na manufaa kwa baadhi ya wagonjwa. Katika miaka ya hivi karibuni, tumegundua kwamba matibabu ya kimwili ya ugonjwa wa F.N.D. ni tofauti na yale yanayotumiwa kwa ajili ya kiharusi au MS kwa njia nyingi. Kwa mfano, wagonjwa wenye kiharusi wananufaika kwa kuombwa wakazie fikira sehemu ya mwili iliyoathiriwa, ilhali katika ugonjwa wa kiharusi, hilo hufanya mambo yawe mabaya zaidi. Tiba ya kimwili kwa FND huendeleza "miendo ya moja kwa moja" na hupunguza mifumo isiyo ya kawaida ya ubongo ambayo imekuwa ikiingilia mwendo. CBT ni kawaida mstari wa kwanza wa matibabu kwa wagonjwa wenye mshtuko wa dissociative (si-epileptic) au mashambulizi kama sehemu ya FND yao na inasaidiwa na majaribio ya kliniki. Tiba inahusisha wakati wa kujifunza zaidi juu ya mashambulizi yao na kutambua dalili fupi za onyo na kujifunza mbinu za kupata udhibiti. Kwa wagonjwa fulani ni muhimu kuchunguza kwa undani zaidi mawazo, hisia, na mambo waliyojionea ambayo yangeweza kuwa na sehemu katika kuanzishwa kwa dalili. Kwa wagonjwa hao wasio na wasiwasi na mshuko wa moyo, tiba ya kisaikolojia yaweza bado kuwa yenye manufaa katika kupata tena uhakika. Kwa kawaida, FMS ni hali ya mkazo na ya kukabiliwa na watu wengi. Aina nyingine za matibabu ya kisaikolojia pia zinaweza kutumiwa kulingana na mgonjwa mmoja-mmoja, kwa mfano Tiba ya Psychodynamic Interpersonal (PIT) ni njia ya matibabu ya kisaikolojia ya matibabu ya kisaikolojia ambayo inasaidia wagonjwa ambao wamepitia majeraha ya kisaikolojia. Tiba ya kazi husaidia wagonjwa kupata marekebisho na kupata tena ujasiri katika uwezo wao wa kufanya shughuli za kila siku nyumbani au mahali pa kazi. Tiba ya kazi inaweza kusaidia kujenga juu ya matibabu mengine ili kuchangia ubora bora wa maisha. Kwa wagonjwa wenye dalili za usemi kama sehemu ya FND, tiba ya usemi ni sehemu muhimu ya matibabu. Kama vile tiba ya kimwili, mbinu ni tofauti na ile inayotumiwa, kwa mfano, baada ya kiharusi na wagonjwa wananufaika na kuona wataalamu wenye uhakika katika eneo hili. Hakuna ushahidi wa utafiti kwamba dawa yoyote ni muhimu kwa ugonjwa wa FMS, lakini inaweza kutumika kwa dalili nyingine za kawaida za ugonjwa wa FMS kama vile maumivu, migraine au wasiwasi. Matibabu mengine yanachunguzwa katika masomo ya utafiti: Si kila mtu aliye na FND anayeweza kufaidika na matibabu hata kama anaelewa hali yake na ana nia nzuri. Maelezo juu ya majaribio ya sasa ya kliniki yamechapishwa kwenye mtandao kwenye www.clinicaltrials.gov. Mafunzo yote yanayopokea fedha kutoka kwa Serikali ya Marekani, na baadhi ya kuungwa mkono na sekta binafsi, ni posted juu ya tovuti hii ya serikali. Kwa habari zaidi kuhusu utafiti wa kliniki unaofanywa katika Kituo cha Kliniki cha NIH huko Bethesda, MD, wasiliana na Ofisi ya Uajiri wa Wagonjwa ya NIH (Toll-Free: 800-411-122-2) na (866-411-1101) na pia kwenye ukurasa ufuatao kwenye tovuti ya NORD (Kwa habari zaidi juu ya majaribio ya kliniki yaliyofadhiliwa na vyanzo vya kibinafsi, wasiliana na: 8126-820-229-851-125-005; simu: 01-821-851-225-005; bila malipo: 01-821-005; ukurasa wa habari ni mali ya www.hospital.org.org.org.org. . Matatizo ya Neurolojia ya Kazi: Kitabu cha Uhandisi cha Neurolojia ya Kliniki (Jarida la 139). Amsterdam: Elsevier 2016. Schacter S, LaFrance Jr WC. Gates na Rowan's Nonepileptic Seizures <unk> Toleo la Tatu. Cambridge, Chuo Kikuu cha Cambridge Press Nielsen G, Buszewicz M, Stevenson F, et al. Randomized utafiti wa uwezekano wa physiotherapy kwa wagonjwa na dalili motor kazi. J. Neurocirurgical Psychiatry, 2017; 88: 488 <9>. Brown, R.J. Reubert, M. Mtazamo wa kuunganisha wa maambukizi ya kisaikolojia yasiyo ya kifafa (PNES). Clin Psychol Rev. 2016;47:5570. Nielsen G, Stone J, Matthews A, et al. Physiotherapy kwa ajili ya matatizo ya utendaji wa motor: mapendekezo ya makubaliano. J. Neurol Neurosurg Psychiatry 2015;86:11139. Jordbrugg, Smedstad, L.M. Klung, O. et al. Ugonjwa wa kutembea kwa njia ya kisaikolojia: Jaribio la kudhibitiwa la kurekebisha mwili kwa kufuatilia kwa mwaka mmoja. Jabil Reh Med. 2014;46:1817. M. Edwards, Bhatia K. Matatizo ya utendaji (psychogenic) ya harakati: kuunganisha akili na ubongo. Lancet Neurol. 2012;11:25060. Goldstein LH, Chalder T, Chigwedere C, et al. Tiba ya utambuzi-mwenendo kwa ajili ya psychogenic nonepileptic seizures: majaribio RCT. Neurology 2010;74:198694. Functional na Dissociative Neurological Symptoms: mwongozo wa mgonjwa. Tovuti ya bure na habari ya kujisaidia kuhusu nyanja zote za FND. "Kama ilivyoelezwa na Dr. Jon Stone, Neurologist, Edinburgh, Uingereza, ""Ugonjwa wa Neurosymptomatic ni ugonjwa wa akili ambao ni hatari kwa afya ya binadamu." Mashambulizi yasiyo ya kifafa. Tovuti ya bure yenye habari za kujisaidia kuhusu mashambulizi ya kutoelewana (yasiyo ya kifafa). "Mwanamke huyo, Markus Reubert, ni mtaalamu wa magonjwa ya neva kutoka Sheffield, Uingereza, na amekuwa akifanya utafiti wa ""Ugonjwa wa kuambukiza ugonjwa wa kifafa"" tangu mwaka 2018."