Functional Neurological Disorder (FND) – An Introduction
PI Aware - July 2019
Functional Neurological Disorder (commonly known as FND) is a condition whereby a person experiences neurological symptoms which have no identifiable organic cause. The condition, which has been known to the medical community for hundreds of years under various different names (including hysteria and conversion disorders), is believed to arise essentially from a dysfunction of the nervous system, but it has only recently come to prominence in the context of personal injury claims.
FND is widely considered to come under the umbrella of somatoform disorders that personal injury practitioners have come to be familiar with, but a question arises as to why has the condition recently emerged as an increasingly visible diagnosis in claims? The answer is simple - experts have begun to correlate FND with trauma, that is to say that it may be triggered by the simplest of accidents or impacts. The “trigger” could be due to the physical or psychological effects of an accident, or a combination of the two. Indeed, the physical/psychological trauma of an accident may be just one of a number of factors that lead to the development of symptoms.
According to a survey carried out in 2015 by FND Hope (an organisation promoting awareness and support for those suffering from or affected by FND):
- The cause of FND was unknown in almost 50% of cases.
- Psychological causes were noted in approximately 17% of cases
- Accidents were considered the cause in 15% of cases
- Surgery was noted as the cause in approximately 6% of cases
Identifying potential FND cases may be the hardest part. FND has historically been a diagnosis of exclusion, so in many cases when tests could not find a neurological, orthopaedic or other clinical cause for the symptoms, FND was diagnosed. This has begun to change with neurologists now making the diagnosis from positive signs. For an insurer, who may have been reserving only for a minor soft tissue injury, such a diagnosis can be very expensive.
Symptoms of FND are diverse and wide-ranging and include functional limb weakness, non-epileptic attacks, sensory problems, incontinence, spasms, cognitive problems and, in extreme cases, paralysis.
The next question is how should FND be treated? As a starting point, treatment cannot be equivalent to that provided for organic orthopaedic or neurological injuries, but instead usually takes the form of intense multi-disciplinary rehabilitation, which will often take place in a specialist facility. In tandem, physiotherapy and psychotherapy are key to “retraining” the brain.
When presented with claims involving FND, insurers may wish to get actively involved in rehabilitation and case management, ensuring that the claimant is not only seen in the right place but by the right people, as incorrect treatment or diagnosis could prove costly for all parties. Neurological and neuropsychiatric assessment will also, of course, be key in terms of maximising the claimant’s recovery.
Recent media reports indicate that with correct and prompt treatment a patient suffering with FND can get ‘back to normal’, but that acceptance of the condition, and crucially its non-organic origin, is a key factor. Equally, however, we know from experience that claimants who do not recover will seek lifetime awards for lost earnings, care, case management, equipment and accommodation needs. Moreover, in the context of a claim it may be uncertain whether the claimant has the right mindset to recover.
FND is also clearly one of those conditions which demands that questions be asked regarding causation. Given that so many people have been diagnosed with FND without an obvious cause, or from causes that are not trauma related, it may be arguable in many cases that the condition could have arisen in any event in response to any other future life stressors.
Accordingly, adopting a forensic approach in terms of considering the available records relating to the claimant’s past (medical, employment and, if appropriate, education records) will be key, as often patients will have displayed prior ‘warning signs’ that they may be more susceptible to the development of this or a similar disorder. Good experts could be the difference in a claim involving FND, and we have been working hard to identify and test a number of approved experts who are leading the field in this area.
In conclusion, FND is a complex and relatively poorly understood condition in the personal injury field and more widely within medicine itself. We are seeing it become more prevalent within personal injury claims, and this trend may continue as the medical understanding of the disorder, and in particular the potential link to trauma or traumatic incidents, develops. In response we have set up a dedicated working group designed to develop a best practice guide to claims handling where FND is or may feature as a diagnosis.