EWJ June 2024 web - Journal - Page 86
Functional Neurological
Disorder and Determining the
Appropriate Therapy Pathway
Functional Neurological Disorder (FND) has been known to the medical community for
centuries under various names such as hysteria, which first appeared in 1880. However,
the recognition of the specific condition of FND occurred relatively recently.
A recent BBC article details the account of Shania
Melvin’s struggles to secure a diagnosis and treatment.
This account is not unique and has wider implications
for those handling FND claims.
can result in poor outcomes. There is also limited
statutory resources for the treatment of FND.
FND in litigation
Perhaps owing to an increased awareness within the
medical community and general public, we have seen
an increase in claims involving FND.
What is FND?
Whilst growing in prevalence in the mainstream
media, FND is not a ‘new’ condition.
To optimise good outcomes for claimants, early
diagnosis and treatment is essential. Currently, treatment will usually be arranged on a private basis.
FND is associated with motor and sensory symptoms,
varying in severity and kind, which are genuinely
experienced, but which are caused by a functional
disorder, rather than a structural/organic disorder.
FND can encompass a wide variety of complex
neurological symptoms, namely:
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Limb weakness or paralysis
Blackouts – these may look like epileptic seizures
or faints
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Movement disorders including spasms, jerky
movements or tremors
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Visual symptoms including loss of vision or
double vision
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Speech symptoms including slurred, stuttering
or whispering speech
Sensory disturbance
Poor concentration and fatigue
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Obtaining early disclosure of medical records can assist
in a prompt decision on causation which can lead to discussions around rehabilitation and treatment. Choosing the right expert team, and engaging in discussions
around settlement are of central importance.
There is no single agreed therapy pathway which, in
turn, has created a division within the market around
the optimal medium for delivering treatment. Some
providers promote inpatient therapy, which can cost
in excess of £100,000. Others encourage a multidisciplinary community-based rehabilitation service and
further light touch approaches are available.
However, what is clear is that there is no ‘one size fits
all’ treatment for FND patients who may present with
different symptoms. Management and treatment requires not only careful assessment but also individualised therapy.
FND is diagnosed usually by a neurologist or
neuropsychiatrist, by identifying neurological signs
that are specific to FND.
When encountering FND cases as lawyers or case
handlers, it is key to seek specialist input from the outset (in both management of FND litigation and from
medico-legal experts). This will help ensure the correct rehabilitation programme is instigated, avoiding
excessive or wasted costs, ultimately with the aim of
improving the claimant’s outcome prospects.
FND treatment
Treatment for FND patients requires bespoke
recommendations, usually from a neurologist, neuropsychiatrist or neuropsychologist with a FND
specialism.
Neuro-physiotherapy can be an effective treatment
for those who have movement or motor symptoms,
such as weakness and walking difficulties. Other treatments include cognitive therapies and neuropsychology, in addition to reducing maintaining factors which
typically include low mood, poor sleep, side effects of
medication and comorbidities such as migraines.
Authors
Ben Appleton, Partner
https://kennedyslaw.com/en/our-people/people/london/ben-appleton/
Ben Drennan, Associate
https://kennedyslaw.com/en/our-people/people/london/bendrennan/
www.kennedyslaw.com
However, there are issues related to the fledgling
status of FND. As there is limited knowledge about
FND, and the causes often being multi-factorial and
complex, patients can be misdiagnosed or the process
to achieve the correct diagnosis can take time. This
EXPERT WITNESS JOURNAL
Original article
https://kennedyslaw.com/en/thought-leadership/article/2024/functional-neurological-disorder-and-determining-the-appropriate-therapy-pathway/
84
JUNE 2024