Diagnosing Functional Neurological Disorder in Croatia. What can be changed?

Abstract

Functional neurological disorders abbreviated “FND” (ICD -10 F44, F45) are defined as various neurological symptoms such as limb weakness, unexplained sensory symptoms, cognitive disorders, gait difficulty, movement disorders, or paroxysmal episodes which are inconsistent and incompatible with current knowledge of known organic neurological diseases (1). The prevalence of FND is estimated to be 50 per 100 000 population per year with an incidence of 4 to 12 per 100 000 population per year (2). Total costs of ED visits and inpatient care of adult FND in the USA are above $1.2 billion annually (1) comparable to hardest-to-treat neurological diseases. Current understanding of FND has advanced with neurobiological data of altered neuronal networks, and the exclusion of necessary stressor agents advancing its understanding from previous definitions such as psychogenic, conversive, or medically unexplained neurological disorders. Combining detailed medical history, and clearly defined positive signs in neurological examination demonstrating inconsistency allows this to be a safe diagnosis with the frequency of misdiagnosis being 4%, and with a rate of reversal of diagnosis being only 0.4% (2). Neurologists› role is paramount in treating FND starting with an adequate explanation of diagnosis, arranging a multidisciplinary treatment plan (physiotherapy, cognitive behavioral therapy by psychologists, and non-pharmacological methods), and follow-up of patients. Early diagnosis, honest follow-up, and discourse show promising results in treating this disorder (3).