MILES TO READ B4 I SLEEP: CWH C1366348 XFNDC

A Functional Neurological Disorder (FND) crisis refers to an acute episode or sudden worsening of neurological symptoms related to FND. These episodes can be frightening and disabling, both for the person experiencing them and those nearby. Here’s a detailed breakdown to help you understand and manage such a situation:

⚕️ What FND Is

Functional Neurological Disorder (FND) is a condition where there is a problem with how the brain and nervous system send and receive signals, without structural damage (unlike stroke or multiple sclerosis). Symptoms are real, involuntary, and can mimic neurological diseases.

⚡ Common Symptoms During an FND Crisis

An FND crisis might involve one or more of the following:

Functional (non-epileptic) seizures (PNES): shaking, collapsing, unresponsiveness, or staring spells without epileptic brain activity.
Sudden weakness or paralysis: often one side of the body, similar to stroke.
Speech difficulties: slurred speech, stuttering, or temporary loss of speech.
Loss of coordination or balance.
Sensory changes: numbness, tingling, or blindness episodes.
Severe fatigue, dissociation, or emotional overwhelm.

🚨 What to Do During an FND Crisis

If someone is experiencing a crisis (or you are), follow these steps:

1. Ensure Safety

Move the person to a safe area — away from sharp edges, traffic, or hard surfaces.
If they fall, do not restrain movements but protect the head (with a jacket or cushion).
Do not force anything into the mouth.

2. Stay Calm and Reassuring

Speak in a calm, steady voice.
Reassure them: “You’re safe. This will pass. I’m here.”
Avoid shouting or giving complex instructions.

3. Time the Episode

Many functional seizures resolve within minutes.
If it lasts longer than 5–10 minutes, or there is injury, breathing trouble, or uncertainty if it’s epileptic, call emergency services (911 or local equivalent).

4. After the Episode

The person may feel confused, tired, or emotional.
Encourage rest and hydration.
Avoid pressing them to recall the episode immediately.

🧠 Managing FND Long-Term

Specialist care: Neurologist familiar with FND + psychological/physiotherapy team.
Therapies: Cognitive Behavioral Therapy (CBT), physiotherapy focusing on retraining movement, and occupational therapy.
Stress regulation: mindfulness, grounding exercises, breathing techniques.
Regular sleep and hydration — both can influence symptom severity.
Avoid overexertion or stress triggers when possible.

🚑 When to Seek Urgent Help

Go to the emergency department or call emergency services if:

You’re unsure if it’s an FND crisis or a new medical emergency (e.g., stroke or epileptic seizure).
The person is injured or not breathing normally.
There’s chest pain, sudden confusion, or loss of consciousness lasting >5–10 minutes.

Would you like me to give you a step-by-step crisis plan (for yourself or someone else with FND) that can be printed or shared with caregivers and emergency responders? It can include what to do, what not to do, and what medical staff should know.

That’s an excellent and very important question.

Let’s go through it carefully and based on current NHS England / NICE / specialist consensus (NNAG 2023, FND Hope UK, and recent Royal College of Psychiatrists guidance):

💊 Drug Treatment in Functional Neurological Disorder (FND)

🔹 1. No primary “drug cure”

There is no medication that directly treats FND itself — because the disorder is related to functional changes in brain–body communication, not structural damage or neurotransmitter deficiency.
Pharmacological management therefore focuses on:

Comorbidities (anxiety, depression, PTSD, pain, sleep)
Symptom modulation (e.g. for fatigue or pain, when appropriate)
Optimising engagement with rehabilitation and psychotherapy

🔹 2. When and why to consider medication

Purpose	Drug class	Rationale	Notes
Comorbid anxiety / depression	SSRIs (e.g. sertraline, citalopram) or SNRIs (e.g. duloxetine, venlafaxine)	Treat mood disorders that exacerbate functional symptoms	Start low, titrate slowly; monitor activation side-effects that can worsen arousal or dissociation
Post-traumatic stress symptoms	SSRIs, prazosin (off-label for nightmares)	Reduce hyperarousal that may trigger episodes	Combine with trauma-focused therapy
Chronic pain / fibromyalgia overlap	Duloxetine, amitriptyline, pregabalin (NICE-concordant use)	Neuromodulation of pain pathways	Use lowest effective dose; avoid polypharmacy
Insomnia	Sleep-hygiene first; short-term melatonin or low-dose sedating antidepressant	Normalise sleep, reduce fatigue	Avoid benzodiazepines (dependence / worsening dissociation)
Functional seizures (PNES)	No antiepileptic drugs unless comorbid epilepsy	Antiseizure drugs show no benefit for PNES	Taper unnecessary AEDs under neurology supervision
Autonomic hyperarousal	Occasionally beta-blockers (e.g. propranolol) for prominent tremor / panic physiology	Symptomatic use only	Avoid in asthma, hypotension

🔹 3. Drugs to avoid or deprescribe where possible

Antiepileptic drugs (AEDs): ineffective for psychogenic non-epileptic seizures (PNES) once diagnosis confirmed.
Benzodiazepines: may reinforce dissociative behaviour and dependency.
Opioids: contraindicated for functional pain — risk of central sensitisation and dependence.
Polypharmacy: increases fatigue and cognitive symptoms.

🔹 4. Integrated approach

Medication should never be stand-alone therapy. Optimal results come from combining:

Education and explanation (clear positive diagnosis)
Specialist physiotherapy (movement retraining)
Psychological therapies (CBT, psychodynamic, or trauma-informed approaches)
Occupational therapy (function and pacing)
Sleep / fatigue management

🔹 5. Prescribing guidance and monitoring

Always review indication, response, and side-effects every 8–12 weeks.
Engage the patient in understanding why a medication is being used (to treat anxiety/pain, not “for FND itself”).
Liaise with the neurology or neuropsychiatry team before altering long-term AED or psychotropic regimens.
Document medication changes in the personalised care and support plan (PCSP).

🔹 6. Key references (UK)

NICE NG127 – Suspected Neurological Conditions: Recognition & Referral (2019)
NNAG 2023 Optimal Clinical Pathway for FND
Royal College of Psychiatrists – Management of Functional Neurological Disorder (2022)
FND Hope UK Clinical Resources (updated 2024)
BNF 2025 – for drug-specific contraindications, dosing and interactions

Would you like me to create a 1-page NHS-style medication summary table (PDF) for clinicians — showing “when to use / avoid / taper” in FND (England 2025 guidance)?

MILES TO READ B4 I SLEEP

Sunday, 9 November 2025

CWH C1366348 XFNDC