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

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

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neurosymptoms.org

Treatment of Limb Weakness

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

 

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

 

1. Weakness

 

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 weakness may have gone months or even years without a diagnosis (or sometimes with an alternative diagnosis like MS).

 

It can take a long time to 'get your head' around a symptom like functional limb weakness. 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 weakness.

 

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 weakness

 

One of the things that patients with functional weakness often notice is that the severity of the weakness can vary in time. So on Tuesday you may feel that your leg is really heavy and dragging but on Wednesday the symptom is much more in the background. 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 weakness.

 

There are several reasons why functional weakness 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 last one is worth some thought. You may have noticed that the more you think about moving your limbs the heavier and more difficult it can be to move them.

 

This is because movement works best when it is automatic. You don't normally think about walking when you're climbing the stairs or walking to the shops. In fact if healthy people do think about walking it often starts to go wrong.

 

Recognising this can help patients with functional weakness.

 

Try, as much as possible, not to think about your movements when you walk. Physiotherapsists are not always sure what to do to help people with functional weakness. Usually automatic movements that use both legs or both arms at the same time are better than exercises that really focus on the limb thats weak.

 

Remember that with functional weakness you are trying to regain control of a limb that may not feel completely like 'yours'. You may have got used to holding it in a certain way

 

People with functional arm weakness tend to cradle it on their lap, especially if its painful as well

 

People with functional leg weakness sometimes find that they sit with the ankle turned in.

 

These positions may feel 'natural' but they are not. Your brain thinks they are normal positions to be in. Your brain may have got used to the idea that one side of your body doesn't feel the same as the other side.

 

The aim of treatment is to try to get your brain to experience normal natural movement again

 

 

 

Other treatments

 

If you're feeling really stuck with your weak limbs then it may be worth trying hypnosis. Sometimes under hypnosis, normal movements can start to occur again.

 

Occasionally patients with severe functional weakness have improved during sedation with a general anaesthetic. This should only be carried if there is paralysis and your doctor has experience with this technique. It is not a 'cure-all' for functional weakness!

 

 

 

 

 

 

 

 

 

 

Learning to overcome functional weakness ...

One of the things that patients with functional weakness often notice is that the severity of the weakness can vary over time.....

...Try, as much as possible, not to think about your movements when you walk....