2023 Sessions - CMSC Scholar

Functional Neurological Disorder and its Relevance in MS

Chair: John F Kramer, PA-C (Vanderbilt MS Center)

Functional neurological disorder (FND) is understood as a disorder that is caused by a problem with the functioning of the central nervous system, and straddles the line between neurology and psychiatry. FND is felt to represent a ‘software’ problem, rather than a ‘hardware’ problem as seen in stroke or multiple sclerosis, and causes day to day neurological impairment in patients who experience FND symptoms. FND, according to one study, is the second most common neurological diagnosis seen in general neurology clinics. FND has positive signs typical of the disorder, leading to improved diagnostic accuracy. MS specialists also commonly encounter patients with symptoms of FND on a routine basis, either at the initial consultation in an attempt to either rule in or rule out the diagnosis of MS, or during the longitudinal course of the disease. Broadly speaking, MS specialists encounter the following clinical scenarios on a routine basis: diagnosis of FND and not MS, diagnosis of MS and not FND, and co-morbid FND and MS. This lecture will review the definition of FND, history of FND, signs/symptoms/diagnosis of FND, and the treatment of FND from the MS Care Team perspective. The importance of recognizing FND in MS clinics is paramount, given the risk of missing the diagnosis of FND can lead to inappropriate treatment with DMTs, treatment of relapses (i.e. pseudorelapses), and inappropriate enrollment in MS clinical trials. Level of information: Intermediate