Today, one of the most serious socially significant problems in many countries of the world is cerebrovascular diseases, in particular strokes, the prevention, and treatment of which are recognized as priority tasks of the health care system. Neurodegenerative diseases (Alzheimer’s and Parkinson’s diseases, amyotrophic lateral sclerosis), multiple sclerosis, epilepsy, and neoplasms in the nervous system have significantly “rejuvenated” in recent years, and now middle-aged people often suffer from them. Other diseases caused by a malfunction of the nervous system are also a serious problem, as they lead to the suffering of patients and a significant decrease in their life quality and work capacity.
This also applies to functional Neurological Disorder – conditions caused primarily by a malfunction of the nervous system rather than a clearly defined pathophysiological disease (such as irritable bowel syndrome and fibromyalgia). These disorders are the second most common reason for neurologist consultations, often seen in an emergency, stroke, and rehabilitation departments. Disorders of the nervous system lead to significant disability and suffering, causing a burden for both patients and health services. Unfortunately, many clinicians often lack specific training in the diagnosis and management of individuals with functional neurological disorders, so these patients often do not receive effective treatment. In practice, this pathology should be diagnosed by specialists with experience in this field. Therefore, patients suspected of this diagnosis are recommended to be referred to secondary care specialists. However, if the primary care specialist has knowledge about such disorders, the diagnosis can be made at the stage of providing primary care, which will contribute to the success of further treatment.
What Is A Functional Neurological Disorder
According to various data, functional (psychogenic) neurotic disorders account for more than 16% of all referrals to neurologists. It is a disorder of the spontaneous functioning of the motor or sensory system with characteristic symptoms such as paralysis, tremors, dystonia, sensory disturbances (e.g., loss of vision), speech symptoms, and seizures. A distinctive feature of such patients is that these symptoms can be defined as those that do not correspond to a recognized pathophysiological disease.
A functional neurological disorder is not a diagnosis of exclusion. Its definition, according to the Diagnostic and Statistical Manual of Mental Disorders, requires the presence of positive diagnostic features denoted by commonly used synonyms such as “dissociative neurological symptoms,” “psychogenic neurological symptoms,” and “conversion disorders,” not just exclusions other states.
One of the diagnostic requirements for a diagnosis of a functional neurological disorder was recent psychological stress, but this has been dropped because many patients have no identifiable stressors. These disorders often coexist with persistent physical symptoms, such as dizziness, pain, and fatigue. Patients may also have other functional disorders, such as irritable bowel syndrome, fibromyalgia, or chronic pelvic pain.
What Should Be The Treatment?
Physiotherapy can help “retrain the brain” so that movements gradually become more automatic again and become normal. Psychotherapy can reduce the symptoms of a functional neurological disorder (understanding what has happened) and address anxiety or mood problems to prevent relapse. It is also worth considering the possibility of other examination methods since concomitant diseases can provoke functional neurological disorders or increase the patient’s vulnerability to them.
