Functional Neurological Disorder and determining the appropriate therapy pathway

Functional Neurological Disorder (FND) has been known to the medical community for centuries under various names such as hysteria, which first appeared in 1880. However, the recognition of the specific condition of FND occurred relatively recently.

A recent BBC article details the account of Shania Melvin’s struggles to secure a diagnosis and treatment. This account is not unique and has wider implications for those handling FND claims.

What is FND?

Whilst growing in prevalence in the mainstream media, FND is not a ‘new’ condition.

FND is associated with motor and sensory symptoms, varying in severity and kind, which are genuinely experienced, but which are caused by a functional disorder, rather than a structural/organic disorder. FND can encompass a wide variety of complex neurological symptoms, namely:

• Limb weakness or paralysis
• Blackouts – these may look like epileptic seizures or faints
• Movement disorders including spasms, jerky movements or tremors
• Visual symptoms including loss of vision or double vision
• Speech symptoms including slurred, stuttering or whispering speech
• Sensory disturbance
• Poor concentration and fatigue

FND is diagnosed usually by a neurologist or neuropsychiatrist, by identifying neurological signs that are specific to FND.

FND treatment

Treatment for FND patients requires bespoke recommendations, usually from a neurologist, neuropsychiatrist or neuropsychologist with a FND specialism.

Neuro-physiotherapy can be an effective treatment for those who have movement or motor symptoms, such as weakness and walking difficulties. Other treatments include cognitive therapies and neuropsychology, in addition to reducing maintaining factors which typically include low mood, poor sleep, side effects of medication and comorbidities such as migraines.

However, there are issues related to the fledgling status of FND. As there is limited knowledge about FND, and the causes often being multi-factorial and complex, patients can be misdiagnosed or the process to achieve the correct diagnosis can take time. This can result in poor outcomes. There is also limited statutory resources for the treatment of FND.

FND in litigation

Perhaps owing to an increased awareness within the medical community and general public, we have seen an increase in claims involving FND.

To optimise good outcomes for claimants, early diagnosis and treatment is essential. Currently, treatment will usually be arranged on a private basis.

Obtaining early disclosure of medical records can assist in a prompt decision on causation which can lead to discussions around rehabilitation and treatment. Choosing the right expert team, and engaging in discussions around settlement are of central importance.

There is no single agreed therapy pathway which, in turn, has created a division within the market around the optimal medium for delivering treatment. Some providers promote inpatient therapy, which can cost in excess of £100,000. Others encourage a multidisciplinary community-based rehabilitation service and further light touch approaches are available.  

However, what is clear is that there is no ‘one size fits all’ treatment for FND patients who may present with different symptoms. Management and treatment requires not only careful assessment but also individualised therapy.

When encountering FND cases as lawyers or case handlers, it is key to seek specialist input from the outset (in both management of FND litigation and from medico-legal experts). This will help ensure the correct rehabilitation programme is instigated, avoiding excessive or wasted costs, ultimately with the aim of improving the claimant’s outcome prospects.