“Is it all in my head?”
What is a Movement Disorder?
A movement disorder is a neurological condition that causes abnormal increased movements, which may be voluntary or involuntary. Movement disorders can also cause reduced or slow movements. Movement disorders include but are not limited to:
Parkinson's disease and Parkinsonism
Dystonia
Chorea and Huntington's disease
Ataxia
Tremor and essential tremor
Myoclonus and startle
Tics and Tourette syndrome
Restless legs syndrome
Gait disorders
Spasticity
Multiple System Atrophy
Progressive Supranuclear Palsy (PSP)
Myoclonus
Tardive Dyskinesia (TD)
Wilson’s Disease
Functional Movement Disorder*
A functional movement disorder is a type of Functional Neurologic Disorder (FND). Functional Neurological Disorders are distressing and disabling neurological signs and symptoms that occur which cannot be accounted for by other known disease entities. FND is caused by a problem with the functioning of the nervous system, not due to damage or structural disease of the nervous system. It is the most common diagnosis seen in a Neurology clinic but most of the public knows very little about this diagnosis, its causes, and treatment. A Functional Movement Disorder (FMD) occurs when you experience unusual, involuntary movements or body positions. It is caused by a problem signal from the brain to the body. Historically, FND was referred to as conversion disorder and was classified as a purely psychological disorder. This inappropriate delineation into the psychological realm only left many people diagnosed with this condition without resources support and correct treatment plan. Since FND and FMD are not caused by damage or disease to the nervous system, getting the right support and treatment team, and treatment plan can lead to full recovery.
Symptoms:
Functional Neurologic Symptoms can present as some of the following:
Functional Limb Weakness
Functional Tremor
Blackouts / Attacks
Functional Dystonia/Spasm
Sensory Symptoms
Functional Walking Problems
Pain
Word Finding Difficulty
Tiredness / Fatigue
Slurred Speech
Sleep Problems
Bladder Symptoms
Poor Memory / Concentration
Bowel Symptoms
Dissociation
Low Mood
Worry / Panic
Swallowing Problems
Dizziness
Complex Regional Pain
Headache
Functional Jerks and Twitches
Health Anxiety
Facial Spasm
Drop Attacks
Post-Concussion Syndrome Symptoms
Visual Symptoms
Usually, all of these symptoms are best seen as part of one illness rather than interpreted as multiple illnesses. These symptoms can have an overlay with other neurologic disorders. Seeking a Neurologist with a background in movement disorder can be extremely helpful in diagnosis and developing a treatment plan and treatment care team.
Treatment:
Due to the variety within FND and FMD, specific treats can vary widely. A multidisciplinary/multi-specialty can be very important to tailor a specific treatment plan. Generally, a treatment plan for FND will include the following specialties/treatment approaches.
Neurologist - medical/Medication management
Physical therapy- graded exposure to movement
Occupational therapy - function return to Activities of Daily Living (ADLs)
Cognitive-behavioral therapy (CBT)- through Speech-language pathology and/or psychology
Neurobehavioral/Neuropsychology plan
Yoga (or relaxation and mindfulness) and Exercise
Family and peer support
FND and FMD are NOT “all in your head” they are very real symptoms, and require structured treatment and support. Changing our outlook and working to better understand these symptoms can begin to break the stigma and improve access to care for improved outcomes!
April is Function Neurologic Disorder Month!
Image credit: fndhope.org
Resources:
https://fndhope.org/fnd-guide/
https://www.emoryhealthcare.org/neurology-conditions/functional-movement-disorders.html
https://www.mayoclinic.org/diseases-conditions/movement-disorders/symptoms-causes/syc-20363893
Cock HR, Edwards MJ. Functional neurological disorders: acute presentations and management. Clin Med (Lond). 2018;18(5):414-417. doi:10.7861/clinmedicine.18-5-414
