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Decoding functional neurological disorder
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Decoding functional neurological disorder

A broad look at how faulty communication between neurons leads to functional neurological disorder
FND-Functional neurological disorder
Representational image for Functional neurological disorder

One day in 2020, London resident Tarka Cowlam, 59, walked into a local town about 15 minutes from her place. That night, she woke up to excruciating leg pain. “My knee was swollen, enlarged and painful,” Cowlam tells Happiest Health.

Recalling the pain, Cowlam says that the ache reminded her of a ligament tear she had after a skiing accident two years earlier.

An X-ray revealed nothing unusual, so the doctors directed her to a physiotherapist. At that time, COVID-19 infections were at their peak and it took her a long time to meet a therapist. However, as her pain subsided, Cowlam says, “I went back to the gym, and I just thought if I exercise a bit more, it would be fine.”

However, her pain returned and then gradually, her walking became unsteady, to the point that the app on her phone notified her she was going to fall over if she didn’t watch out. “I couldn’t walk straight; my leg went to a side and flipped. My legs felt as if they weren’t attached to my body and were stiff,” says Cowlam. Then, finally, last September, after undergoing a diagnostic test called Hoover’s test and a brain MRI, she was diagnosed with a rare neurological condition – functional neurological disorder, FND.

Understanding FND

The functional neurological disorder is like a software bug in the brain which disrupts the brain’s normal functioning, says Dr C P Ravi Kumar, consultant, paediatric neurology, at Aster CMI Hospital in Hebbal, Bengaluru. “FND is not related to a structural change in the brain but the way the neurological system works or functions,” he clarifies. Explaining further with another analogy, he says a computer not working correctly could also result from a software malfunction and not because of a hardware defect.

In FND, the brain cannot correctly receive and send signals to the body and thereby fails to control the body’s movement.

A haze of symptoms

Not everyone with FND experiences the same symptoms. Cowlam’s early signs were leg pain and walking difficulty. She says she has episodes of peculiar seizures arising from the intense leg pain and then spiralling into a panic attack. Sometimes, her legs shake. “When I  focus on it, the shakiness increases; however, if I ignore it, it reduces,” she explains.

Other symptoms associated with FND are weakness in muscles, headache, jerky body movements and speech-related difficulties.

Causes of FND

While research has yet to find the roots of FND, the presence of other neurological conditions increases the chances of FND.

One of its causes may also be emotional stress or psychological trauma, say experts. Dr Kumar shares details of a teenager’s condition.

The teenager was an adopted child but did not know it. One day when she overheard the hidden truth about herself, she was livid but could not express or confront her adoptive parents about it. Her inner turmoil began causing what appeared like seizures but was not.

She underwent several treatments but to no avail. All medical assessments were negative for any abnormalities; her parents also kept denying any psychological issues.

Dr Kumar says, “We had to put across the point that we feel this is psychological rather than neurological. Since parents deny that there is a problem, we [were] unable to cure her completely.” He directed them to other doctors, and eventually, the underlying problem of FND was discovered.

The teenager is doing well with psychological counselling and medicines, says Dr Kumar.

Treatment options

There is no specific treatment for FND, says Dr Kumar. However, pain and seizures can be managed with medicines. One can handle the condition effectively and perform routine activities with rehabilitation therapy –for example, physiotherapy and occupational and psychological therapy.

Keeping oneself mentally and physically occupied is paramount to well-being. It helps further to cultivate, as Cowlam found out. She says she started knitting and drawing when nothing worked for her.

Cowlam is also keen on helping others with their pain management. She advocates training the mind to get a better outlook on life.

Now, in place of insecurity, she is positive about her future. She says she has learnt to accept her condition and is grateful for all that she has in life.

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