Multiple sclerosis (MS) is a debilitating autoimmune disorder that affects the central nervous system, causing a wide range of symptoms including fatigue, muscle weakness, and problems with coordination and balance.

However, in some cases, MS can mask another underlying disorder that can be difficult to diagnose and treat: functional neurological disorder (FND).

What Is Functional Neurological Disorder (FND)?

FND is a condition that affects the functioning of the nervous system, leading to a wide range of neurological symptoms such as tremors, seizures, and paralysis.

Unlike MS, FND is not caused by damage to the nervous system, but rather by a disruption in the way the brain processes and controls bodily movements.

Although the exact cause of FND is unknown, it is thought to be related to psychological or emotional factors such as stress, trauma, or anxiety. In some cases, FND may develop after a physical injury or illness that affects the nervous system.

Why Is FND Difficult to Diagnose?

One of the main challenges in diagnosing FND is that there are no specific tests or imaging studies that can confirm the condition.

Instead, the diagnosis is based on a thorough neurological evaluation and ruling out other underlying medical conditions.

Moreover, FND symptoms can vary widely from person to person and may mimic other neurological disorders such as MS or Parkinson’s disease.

For example, some people with FND may experience numbness and tingling sensations similar to those seen in MS, while others may have episodes of uncontrolled shaking or tremors.

How Can MS Mask FND?

Because FND symptoms can closely resemble those of MS, it is not uncommon for people with FND to receive a misdiagnosis of MS or to be mistakenly treated for MS for many years.

This can delay appropriate treatment for FND, which can worsen symptoms and lead to unnecessary medical procedures and treatments.

Furthermore, some studies suggest that there may be a link between MS and FND, with some people with MS being at a higher risk of developing FND.

This is thought to be due to the effects of chronic stress, anxiety, and depression on the nervous system in people with MS.

Diagnosing FND in People with MS

Given the difficulty in diagnosing FND and the potential for misdiagnosis in people with MS, it is important for healthcare providers to be aware of the possibility of FND in this population.

One key factor in distinguishing FND from MS is the pattern of symptoms. While MS symptoms tend to be consistent over time and may gradually worsen, FND symptoms often wax and wane, and may be triggered by psychological or emotional stressors.

Other factors that may suggest an FND diagnosis include:.

The presence of multiple neurological symptoms that do not fit a specific pattern
Unexplained changes in symptoms or the sudden onset of symptoms without a clear cause
The absence of abnormalities on standard imaging studies such as MRI or CT scans
A lack of response to MS treatments

Treating FND in People with MS

Because FND is not caused by damage to the nervous system, treatment focuses on addressing the underlying psychological or emotional factors that may be contributing to the condition.

This may involve a combination of psychotherapy, medication, and physical therapy.

In some cases, cognitive behavioral therapy (CBT) or other forms of talk therapy can help people with FND learn to manage stress and anxiety and develop coping strategies for their symptoms.

Medications commonly used to treat FND include antidepressants, anti-anxiety medications, and antipsychotics. These medications can help address underlying psychological factors such as depression or anxiety that may be contributing to FND symptoms.

Physical therapy may also be helpful for people with FND, particularly those who experience movement-related symptoms such as gait disorders or tremors.

Physical therapists can help people with FND develop new movement patterns and learn coping techniques for their symptoms.

Conclusion

FND is a complex disorder that can be difficult to diagnose and treat, particularly in people with MS who may have similar symptoms.

However, by remaining vigilant and considering FND as a potential diagnosis in people with MS who have atypical symptoms, healthcare providers can help ensure that people with FND receive appropriate treatment and improve their quality of life.