Functional Neurological Disorder (FND) : a patient's guide

including Functional/Dissociative (non-epileptic) Seizures,  Functional Movement Disorder and other functional symptoms

Hemi

neurosymptoms.org

Treatment of Tremor / Spasms

 

 

This section is based mainly on the authors own experience in trying to assist many  patients with functional movement disorders to get better.

 

If you haven't read them yet, have a look at these sections before you read on:

 

1. Tremor, Spasms and Walking Problems

 

Its really important to understand that this symptoms are common, does not mean you are going mad or 'losing it', and are potentially reversible without medication.

 

2.  Understanding the diagnosis

 

Its essential that you feel the doctor has looked in to your case properly and come to the correct diagnosis.

 

3. Physiotherapy and exercise

This explains some basic principles behind rehabilitation and exercise for functional symptoms including weakness, pain and fatigue

 

4. Psychology? I'm not crazy

 

If your doctor has referred you to a psychologist or psychiatrist you may be wondering why. Read this section to help you understand this

 

 

 

 

 

 

We are still learning more about what kinds of treatment work best for patients with functional weakness.

 

 

Understanding it

 

It can be suprising how much impact simply receiving a clear and understandable explanation for the symptom can have. Often patients with functional movement disorder may have gone months or even years without a diagnosis (or sometimes with an alternative diagnosis like parkinsons disease).

 

It can take a long time to 'get your head' around being diagnosed with a functional movement disorder. For patients that do start to feel better, doing this seems to be an important part of it

 

Seeing how it fits in with all your other symptoms can also be an important part of understanding it. It can help to understand that your weakness is one symptom among many (usually pain, fatigue and sleep disturbance) and that you have one illnes swith many symptoms, not many symptoms caused by different diseases.

 

For this reason, it is probably the case that some of the treatments that are proven to be effective for patients with chronic fatigue syndrome/ME and chronic pain are also helpful for patients with functional movement disorder.

 

these include

 

1. Graded exercise / physiotherapy

 

2. Cognitive behavioural therapy

 

3. Medication to help pain and sleep

 

 

Specific things that come up in relation to functional movement disorder

 

Intermittent movement disorder

Some patients with tremor experience 'bouts' of tremor. These episodes may be preceded by dissociative symptoms. Although patients with this do not black out, the advice on treatment and learning to avert attacks may be similar to that for dissociative seizures. Have a look at the two treatment pages for dissociative seizures and see if anything applies to you.

 

 

Think about how variable it is

Variability is a common feature of many functional symptoms. If you think about it, its one reason why the diagnosis of functional symptoms makes sense. If there was structural damage to the nervous system, the symptom might fluctuate a bit but not dramatically as it can do with functional movement disorders.

 

There are several reasons why functional movement disorders can vary in severity:

 

1. At times of greater fatigue

 

2. At times of greater pain

 

3. When you are thinking consciously about movement, this may be especially the case when you are sitting resting and not doing very much or lying in bed.

 

This last one is worth some thought. You may have noticed that the more attention you pay to your movements the worse they get.

 

Try, as much as possible, not to think about your movements. Remember that with functional movement disorder you are trying to regain control of a limb that may not feel completely like 'yours'.

 

Sometimes patients report that having their tremor or abnormal posture feels 'natural' whereas having a limb that is in the normal position or still feels unnatural.

 

You may need to train your brain so that the normal position starts to feel natural again. Read Anna's Story on the Cases page for an example of this.

 

Try these specific things for individual symptoms.

 

Functional Tremor

(with thanks to Glenn Nielsen, Physiotherapist at Institute of Neurology, London)

 

Physiotherapy

All of these need to be practised repeatedly, and many will seem impossible or difficult to begin with. You are trying to break a 'habit' in your brain, that is not easy to do.

 

1. Attempt to make a voluntary tremor 'on top' of your existing tremor, perhaps with a sweeping arm movement like the conductor of an orchestra. then change the movements to wider and slower movements eventually bringing it to a standstill. Does your functional tremor stop briefly when you do this? Keep practising to see if this helps you get better control

 

2. See if you can 'interfere' with the rhythm of your functional tremor by making a rhythmical movement with your "good" arm or leg. Ask a friend to make a tapping movement that you have to copy. The friend should start off with a steady rhythm but then speed up and slow it down which will make it harder for you to keep  up. If the rhythm of the functional tremor changes depending on this 'external' rhythm, you could see if it's possible to slow the external rhythm right down until perhaps it stops.

 

3. Learning to contract and relax muscles. Functional tremor often comes about because the person is contracting all the muscles of their arm or leg at once. Learning a technique called progressive muscular relaxation can help you get more control back over muscle contraction

 

4. Look in a mirror when trying to do this. This may help your brain learn where it's going wrong

 

5. If your leg keeps 'bouncing' when you are sitting down, practise keeping your foot flat on the floor for as long as you can. It may feel odd when you do that, but you are

 

 

It may be worth trying hypnosis. Sometimes under hypnosis, tremor may improve and you may be able to learn self hypnosis to practice at home

 

 

Link with anxiety

Functional tremor, can in some patients, be especially linked to anxiety. 

 

Commonly feelings of anxiety link to the tremor itself, what will people think about me? Am I going to start shaking all over? Will that be embarrassing? But these are still feelings of anxiety

 

Many patients with functional tremor don't have anxiety, but if you do, it may be important to face up to that and seek specific treatment directed at controlling excessive worry. This can sometimes help.

 

Some patients report that episodes of tremor appear to 'get rid' of a build up of hard to describe, tense, dizzy symptoms. They don't want the tremor to happen, but recognise that when it does (if it happens as 'episodes') that it does seem to lessen those feelings. If this applies to you then it may be useful to discuss that with your treating health professional.

 

 

Functional Dystonia

We are still learning what specific techniques are most helpful for functional dystonia.

As a general principal, trying to move the affected part is really important, although if its fixed this may not be possible.

 

Some of the following may be helpful.

 

1. Changing sitting and standing postures

 

2. Desensitise the limb using techniques learned for complex regional pain syndrome

 

3. Looking in a mirror to give your brain feedback that the limb is not in the right position. For example, some patients report that they feel as if the foot is straight even when its actually bent.

 

4. Using a mirror to 'trick' your brain into thinking that the abnormal foot or hand is normal. This is the same technique used in patients with Phantom Limb Pain and is also used in CRPS.

 

5. Practising 'imagining your foot or hand in a normal position again.

 

Additional treatments that are sometimes used in functional dystonia include

 

Hypnosis . In a state of hypnosis some people become aware that the dystonia improves or even disappears temporarily. Learning to experience the altered state of being in hypnosis or carrying out 'self-hypnosis' can be helpful for some patients

 

Sedation. This  is only potentially useful in patients with 'fixed' dystonia who are unable to experience their limbs in a normal position at any other time. This also allows examination for any contractures. If this is handles correctly it can encourage normal movements which the patient has not experienced for a long time. This should only be carried out if your doctor has experience with this technique. It is not a 'cure-all' for fixed dystonia

 

 

Walking problems (Functional Gait Disorder)

 

1. Try humming a tune or singing a song (in your head if you need to!) while walking. Has this made it easier to walk?

 

2. Try walking backwards if you have difficulty walking. Walking backwards is a different 'program' in the brain and you may be surprised to find that its easier than walking forwards.

 

3. Running. For patients that are able, sometimes a slight jog makes it easier to move. This is a bit like someone with a stutter who has problems speaking but can sing normally.

 

 

 

 

 

 

 

 

 

 

 

Learning to overcome functional movement disorders ...

Foot bent2 - small Clenched fist - smal tremor