Specialist
Treatment

Snapshots of relevant medics 

We do not pay much attention to this subject. We are not doctors. Your GP should be better placed to give you this advice. If you can find a specialist to take you on, then please follow their lead.

The information below is designed for the complete beginner who is trying to get an overview of the role of each speciality in FND treatment and how they might be able to help. 

When we first got sick we noted that the different types of FND, and the different types of treatment, seemed to be lumped together. In this section we try to untangle this a bit. 

It might be worth while talking with a clinician before seeing them. Ask them if they have treated people with FND before and what their approach is. Some clinicians have some downright harmful attitudes about FND. We would rather that you identify the rotten apples before you end up paying for harmful service. 

Medication 

There are no real pill based solutions to the problem of FND. As we are not doctors, here is what Professor Jon Stone has to say about medication and FND. 

Neurology 

A Neurologist is a specialist physician who diagnoses and treats conditions of the brain, spinal cord and nerves. This can include muscle diseases and disorders that affect thinking and behaviour. Often a Neurologist will be the one to diagnose you, either at the hospital when turning up at A&E, or after referral as an outpatient. Other specialists such as the A&E Doctors, Psychiatrists and Clinical Psychologists can diagnose too. 

Many people do not get to see a Neurologist as there is a shortage, and FND patients are not considered a priority compared to people with other disorders. If you cannot get to see a Neurologist then don't worry too much. They rarely have anything to offer other than a referral to Neurophysiotherpy. Some of our people have told us that they have been unable to access further treatment without being able to see a Neurologist first for the referral. 

It is also very difficult to find a Neurologist to treat FND patients privately. Approximately 30% of our recent research participants had not managed to see a Neurologist. Most of these people had given up trying. 

If you have positive FND symptoms such as seizures, myoclonus, and ticks a Neurologist is likely to be of little help to you as they are unlikely to refer you on for therapeutic support. If you have negative FND symptoms, such as weakness and paralysis, then it might be a good idea to push to see a Neurologist as a referral to a physio may be of benefit to you. 

Neuro Psychiatry 

Neurology and Psychiatry are fields that detect and treat very specific symptoms. Neuropsychiatrists treat physical and mental problems that fall into that “middle zone”. Neurology focuses on motor and sensory functions, while Psychiatry is all about behaviour, mood, thought and affect. Neuropsychiatry  focuses on the diagnosis and treatment of mental disorders that are associated with disturbances in the nervous system.

Neuropsychiatrists use their expertise to evaluate patients who present with FND. However a Neuropsychiatrist is likely to diagnose you with Conversion Disorder under the DSM, rather than FND. Many of our people have reported that seeing a Neuropsychiatrist has helped them recover. These specialists are often involved in ACC assessments of FND. 

Functional Neurology 

Functional Neurologists do not train through normal medical channels. They come up through the discipline of Chiropractic medicine. They are highly trained specialists. Typically, a Functional Neurologist serves in the same consulting manner as a Medical Neurologist. The difference is that the therapies or applications of a Functional Neurologist do not include drugs or surgery.

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As a result, certain conditions are more customarily seen by a Functional Neurologist as opposed to a Medical Neurologist, and vice versa. Specifically, Functional Neurologists see patients with a variety of movement disorders, such as dystonia. Functional Neurologists can provide therapies and treatments as well as counsel when there is a diagnostic dilemma or a question of appropriateness of care. 

Many of our people have reported that seeing a Functional Neurologist has helped them recover. This treatment is likely to involve elimination diets. 

Physiotherapy 

Physiotherapy can be helpful for people with symptoms affecting voluntary movement. This includes weakness, tremor, dystonia, and problems with walking and balance. The main aim of Physiotherapy is to retrain movement patterns and restore normal automatic functioning. 

One local Physiotherapy business has written a good FND page which explains what happened in FND physio sessions. 

Please establish when booking your appointment if your Physiotherapist can help with your specific symptoms. Physiotherapists have been known to charge people $140 to then say they cannot help. Check this out early and save yourself some money. 

Social Workers 

Some of our group members have recommended seeking help from social workers, particularly if you are struggling to communicate with doctors at times of distress. You can ask for a Social Worker at the hospital if you feel that you need one. 

Occupational therapy 

Occupational Therapists help people participate in daily activities. The ‘occupation’ in occupational therapy does not only refer to paid work, but also to all other daily activities e.g. getting washed and dressed, meal preparation, housework, child care, leisure activities, shopping, using public transport etc. Occupational Therapists can help people with movement problems , but they can also help with symptoms of fatigue, pain, dissociative seizures, cognitive difficulties, low confidence, anxiety and low mood. Occupational Therapists work with people with FND to identify the impact that symptoms have on abilities to carry out daily activities. Treatment will help find ways to improve abilities, participation independence and confidence.

Psychological therapy 

Psychologists and Psychotherapists use different treatment approaches, such as Cognitive Behavioural Therapy (CBT), to promote mental well being. Generally you sit in a room with a Therapist and talk things through and learn survival tools. 

Often this is the only therapeutic approach recommended to those with positive FND symptoms such as dissociative seizure and disordered movement. 

This type of therapy is hard to come by in Aotearoa. If you have suffered sexual assault in the past, the best path to therapeutic support might be through an ACC sensitive claim. These can be challenging to get through, but they do offer a pathway to therapeutic support of this kind. 

Speech therapy 

Speech Therapists help with speech and swallowing. They will assess your needs and look at the impact that your symptoms are having on your daily life. Speech therapy could help you if your symptoms suit their skills. This therapy works on directly alleviating symptoms,  or indirectly though learning about symptoms. 

Some of our members have used Speech Therapists and they have found it very helpful, It is only relevant for a few specific symptoms however.