{"id":40037,"date":"2021-06-08T15:47:47","date_gmt":"2021-06-08T21:47:47","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=40037"},"modified":"2025-01-17T13:08:53","modified_gmt":"2025-01-17T20:08:53","slug":"functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\/","title":{"rendered":"Functional neurological disorder straddles two worlds: neurology and psychiatry"},"content":{"rendered":"
<\/div>

For both women, the symptoms arrived without warning and apparently without reason.<\/p>\n

Ronda Palazzari of Thornton first noticed a bladder issue that seemed to be an infection but wasn\u2019t. Then came the headaches and the tremors. Exercising one day, she couldn\u2019t lift her right foot. Tinglings like electric shocks ran down her legs. Severe pain behind her right ear tormented her. On Christmas Day 2016, Palazzari was unable to get out of bed because her legs were paralyzed.<\/p>\n

Khamryn Snow of Boulder felt unexplained pain and tremor invade both her arms and legs. Numbness and pain that shot through the legs left her unable to drive. The left side of her body became hypersensitive, making a fall or contact agonizingly painful.<\/p>\n

\"Ronda
Ronda Palazzari (left) traveling with a friend. Palazzari has had success managing her functional neurological disorder symptoms since Dr. Holden\u2019s diagnosis in 2017. Photo courtesy of Ronda Palazzari.<\/figcaption><\/figure>\n

Both felt their brains betray them. Their thinking clouded. They searched for words that once had been easy to retrieve. Their frustration and aggravation grew.<\/p>\n

\u201cI had a memory that was sharp as a tack,\u201d Palazzari, 50, said. \u201cBut I suddenly couldn\u2019t locate a word in my head.\u201d<\/p>\n

\u201cYou keep reaching out to find a word and you just can\u2019t,\u201d said Snow, 37. \u201cI had trouble articulating what was going on.\u201d<\/p>\n

The problems took a toll. Palazzari had to stop working in January 2020, while the physical toll forced Snow out of regular employment in 2009.<\/p>\n

A hard diagnosis to find<\/h2>\n

But their burden was even heavier. For years, no one could tell Palazzari or Snow what caused all the torment. Some providers dismissed it or offered glib explanations. \u201cSounds like you need more sleep,\u201d one neurologist told Palazzari after she submitted to an MRI, blood work and a review of her medical records. Some of their providers were sympathetic but puzzled because they could find no definitive source for the pain.<\/p>\n

Functional Neurological Disorder: the junction of two worlds<\/strong><\/h2>\n

But there was a cause \u2013 one that straddles the realms of neurology and psychiatry called functional neurological disorder (FND). It\u2019s frequently misunderstood but surprisingly prevalent, said Dr. Samantha Holden<\/a>, assistant professor of Neurology at the University of Colorado School of Medicine. Holden practices at the UCHealth Neurology Clinic \u2013 Central Park<\/a>, specializing in movement and cognition disorders.<\/p>\n

In functional neurological disorder, patients experience physical and cognitive problems because of disruptions to the signals that the brain sends the body, Holden explained. A symptom like the shooting pain Palazzari and Snow experienced might mimic the discomfort caused by a pinched nerve<\/a>. But an imaging test would show no nerve damage. As Holden and others explain, the source of their pain is not the body\u2019s physical nerves or organs \u2013 in computer terms, their hardware. Rather, the problem is in the software \u2013 the messages from the brain and the way the body interprets them.<\/p>\n

Holden said FND is the second-most prevalent neurological diagnosis<\/a>, behind only headache, but until relatively recently it was too often \u201cbrushed aside as something not real, in your mind, not your brain.\u201d As a result, many people with FND make repeated trips to the hospital or emergency room, only to be tested and told nothing is wrong, Holden added.<\/p>\n

\u201cPatients are often put in a position of having to prove they are not faking,\u201d she said. That sets up \u201cadversarial mistrust\u201d on both sides.<\/p>\n

\u201cDoctors can get frustrated when they can\u2019t find something with a test,\u201d said Dr. Laura Strom, associate professor of Neurology at CU. Strom practices at the UCHealth Neurosciences Center \u2013 Anschutz Medical Campus<\/a> and is medical director of the multidisciplinary FND Clinic<\/a>, which includes a psychiatrist, a licensed clinical social worker, a nurse practitioner physician assistants and staff. Strom is a fellowship-trained epileptologist who specializes in treating non-epileptic seizures (NESs) \u2013 one of many forms FND takes.<\/p>\n

\"Khamryn
Khamryn Snow struggled with functional neurological disorder for many years before getting help from Dr. Holden. Photo courtesy of Khamryn Snow.<\/figcaption><\/figure>\n

Mental health \u2013 symptoms are real<\/strong><\/h2>\n

The solution to the frustration of both patients and providers, Strom said, is to recognize that functional neurological disorder is a genuine condition that affects both the mind and the body and requires the expertise of both neurologists and psychiatrists. Sigmund Freud, the founder of modern psychoanalysis, she noted, was a neurologist who realized that many of the functional problems his patients experienced couldn\u2019t be measured with a reflex hammer because they originated in the brain, spurred by unconscious memories of past pain.<\/p>\n

In Freud\u2019s conception, these patients \u201cconverted\u201d their mental struggles to physical issues, giving rise to the term \u201cconversion disorder,\u201d which the Diagnostic and Statistical Manual (DSM) used until relatively recently adding the term\u00a0 \u201cfunctional neurological symptom disorder.\u201d<\/a> The key point, Strom said, is that in patients with FND, the physical and the mental \u2013 body and brain\u2014are often tightly intertwined.<\/p>\n

\u201cThe overriding concept in FND is that these are real patients with real problems, and it is highly associated with trauma,\u201d Strom said.<\/p>\n

Testing for the root causes<\/strong><\/h2>\n

Both Strom and Holden test patients extensively to identify neurological problems like epilepsy, Parkinson\u2019s disease, multiple sclerosis and a host of other conditions that functional neurological disorder can mimic. But both emphasized the importance of helping patients understand that FND is a positive diagnosis \u2013 a confirmation that what they experience is real.<\/p>\n

\u201cI tell patients I know a lot about the <\/em>brain, but they know a lot about their <\/em>brain,\u201d Holden said. \u201cI need them to meet me in the middle and say, \u2018Yes, that fits,\u2019 or \u2018No, that doesn\u2019t, based on my experience.\u2019 It really is a partnership in building back up trust that has been destroyed.\u201d<\/p>\n

Holden said she spends at least 90 minutes with patients in an initial examination to identify and categorize their symptoms and identify triggers for them, like stress, and other conditions that might worsen them. Khamryn Snow, for example, also has multiple sclerosis, the symptoms of which overlap with her FND. Holden helped to arrange an MRI for Snow that produced the MS diagnosis.<\/p>\n

Tests and input from patients help Holden suggest approaches to mitigate symptoms. Cognitive behavioral therapy<\/a>, for example, helps relieve depression, anxiety and trauma that disrupts the brain\u2019s circuitry with unpredictable results. Physical therapists assist in managing movement problems and reducing physical pain.<\/p>\n

\"Neurologist
Neurologist Dr. Samantha Holden diagnoses and treats movement disorders caused by FND. Photo by UCHealth.<\/figcaption><\/figure>\n

In addition the CU Departments of Neurology and Psychiatry collaborate in a multidisciplinary group therapy clinic<\/a> for patients diagnosed with NESs. Strom said the clinic is a \u201ctreatment arm\u201d that she believes will be adequate to eventually treatment patients with \u201call manifestations\u201d of FND, including those with movement, gait, sensory and vision disorders, and any other neurological symptom without a clear source.<\/p>\n

The key: listening to patients<\/strong><\/h2>\n

But as Holden emphasized, treatment for functional neurological disorder begins with patients recounting their experiences and specialists taking seriously what their patients recount about their struggles.<\/p>\n

\u201cThe number-one thing I do is listen and validate what they tell me,\u201d she said.<\/p>\n

Both Ronda Palazzari and Khamryn Snow credit Holden for relieving the frustration that mounted as they battled their mysterious symptoms.<\/p>\n

Palazzari recalls that her family physician sent her to a neurologist for help with crushing pain behind her right ear, as well as her tremors. The neurologist ordered an MRI, concluded that the pain came from her trigeminal or occipital nerves and prescribed the drug gabapentin to treat it. She said he dismissed her questions about tremors as something people get all the time.<\/p>\n

The head pain didn\u2019t go away, even as Palazzari increased the gabapentin to the maximum dose. \u201cMy head pain was a 10,\u201d she recalled. \u201cI could hardly get out of bed.\u201d<\/p>\n

She struggled, meanwhile, to raise her teenage kids and maintain full-time work as director of operations for a church. The burden increased when she began experiencing feeling sensations of electric shocks coursing through her legs and pins and needles in her hands.<\/p>\n

On her own, Palazzari sought out an acupuncturist who helped decrease her pain and her dosage of gabapentin. But still the problems persisted, and when a second neurologist dismissed her issues with the directive to get more sleep, she quickly moved on, telling her family she wanted to go to UCHealth to find an answer for her very real torment.<\/p>\n

The role of stress and trauma<\/strong><\/h2>\n
\"Neurologist
Neurologist Dr. Laura Strom treats non-epileptic seizures, one form of functional neurological disorder. Photo by UCHealth.<\/figcaption><\/figure>\n

After enduring the mysterious three-day Christmas Day paralysis, Palazzari saw Holden in May 2017. She described the meeting as \u201cLife changing.\u201d With the quip, \u201cYou\u2019re not crazy, but it is all in your head,\u201d Holden told Palazzari she had functional neurological disorder, gave her information about it, and let her know that much work lay ahead to help her \u201creset the brain.\u201d<\/p>\n

Part of that work involved dealing with mental, physical and sexual abuse that Palazzari said she experienced as a child. Holden recommended CBT as a way to address the stress and trauma of the abuse and their possible connection to her FND. Palazzari also received physical therapy from Christine Cedilotte at UCHealth Physical Therapy and Rehabilitation Clinic \u2013 Central Park<\/a> and Marcus Kurek at UCHealth Boulder Health Center<\/a>. Kurek specializes in treatment of patients who have endured trauma.<\/p>\n

Meanwhile, Holden encouraged Palazzari to continue to manage her FND symptoms with acupuncture, massage therapy<\/a>, restorative yoga and meditation.<\/p>\n

Snow also identifies stress as a contributor to her FND. It\u2019s the result, she said, of middle and high school bullying in Boulder that led to an anxiety disorder that she recognizes as a trigger for her FND. She describes \u201cbrain fog\u201d that creates a \u201ccyclical situation\u201d of clouded thinking that increases her anxiety and further envelops her brain.<\/p>\n

During the anxiety attacks, Snow said, she feels \u201clost in an abyss, adrift, not sure what to do with the rest of [my] life. You have hopes and dreams but getting from point A to point B is difficult.\u201d<\/p>\n

Snow found Holden through FND Hope<\/a>, an organization that raises awareness of the condition through a variety of channels, including a Facebook support group. Snow said Holden helped her simply by listening to her and believing her.<\/p>\n

\u201cShe makes sure I know I\u2019m not crazy,\u201d Snow said. \u201cThat is so important. I don\u2019t know where I would be without her.\u201d<\/p>\n

Many management techniques for Functional Neurological Disorder<\/strong><\/h2>\n

Holden helped Snow get treatment for her anxiety disorder, referred her to a sleep neurologist, and assisted in getting the MRI that produced the MS diagnosis. Snow also gets physical therapy in the form of stretching and light exercise, which is important for both her FND and MS.<\/p>\n

\"A
A sample of jewelry created by Khamryn Snow, who also has discovered her artwork helps her manage her FND. Photo courtesy of Khamryn Snow.<\/figcaption><\/figure>\n

Like Palazzari, Snow has also discovered other techniques that help manage her symptoms, including reading, video games, group chats with a small circle of friends and \u201cworld building\u201d \u2013 that is, creating her own fantasy realms. She creates her own one-of-a-kind jewelry pieces, takes weekly classes at the Boulder School of Metals and hopes to start her own business. Cutting metal, soldering, drawing and coming up with new ideas, she said, helps her to focus on something other than the problems FND spurs.<\/p>\n

Art has also helped Palazzari, who is a multi-media specialist with her own line of stencils and other products. After an FND-forced hiatus, she\u2019s revived her business and made it part of her path to recovery, along with exercise, diet and strict attention to her physical and emotional limitations as part of her path to recovery.<\/p>\n

The two women are realistic about the state of their health. Snow calls her FND \u201cpretty stable and fairly under control.\u201d She acknowledges that she hasn\u2019t undone the damage of the past, \u201cbut I\u2019m not doing more.\u201d<\/p>\n

Recognizing the reality of Functional Neurological Disorder<\/strong><\/h2>\n
\"A
A page from Ronda Palazzari\u2019s Art Journal entitled \u201cControl.\u201d Palazzari says she uses art therapy as treatment for her FND. Photo courtesy of Ronda Palazzari.<\/figcaption><\/figure>\n

Palazzari said she\u2019s learned that to manage her FND symptoms, she must reduce her stress. She said she has come a long way from the physical and mental depths into which she\u2019d plunged before seeing Holden, but knows she must continue to manage her symptoms.<\/p>\n

\u201cIn order to be the best I can be in this body I have now, I have to maintain positivity and keep going,\u201d she said.<\/p>\n

Both have firm words for those who may not understand FND and for those fighting it.<\/p>\n

\u201cDon\u2019t assume. Functional neurological disorder is such an invisible disease that every day feels like a challenge,\u201d Palazzi said. \u201cJust because we \u2018look great\u2019 on the outside doesn\u2019t mean there isn\u2019t a battle going on in our bodies.\u00a0 We are just used to dealing with it on a daily basis.\u201d<\/p>\n

\u201cIt\u2019s not made up. It\u2019s real,\u201d Snow added. \u201cYou\u2019re experiencing it and should take it seriously because there are things you can do to help and there are people who can help.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

For both women, the symptoms arrived without warning and apparently without reason. Ronda Palazzari of Thornton first noticed a bladder issue that seemed to be an infection but wasn\u2019t. Then came the headaches and the tremors. Exercising one day, she couldn\u2019t lift her right foot. Tinglings like electric shocks ran down her legs. Severe pain […]<\/p>\n","protected":false},"author":2143,"featured_media":40038,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[113,184,4624],"class_list":["post-40037","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-behavioral-health","tag-neurology","tag-neurosciences-outcomes"],"acf":[],"yoast_head":"\nFunctional Neurological Disorder straddles two worlds - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Functional Neurological Disorder produces baffling symptoms that may require treatment by neurologists and psychiatrists.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Functional neurological disorder straddles two worlds: neurology and psychiatry\" \/>\n<meta property=\"og:description\" content=\"Functional Neurological Disorder produces baffling symptoms that may require treatment by neurologists and psychiatrists.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.uchealth.org\/today\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\/\" \/>\n<meta property=\"og:site_name\" content=\"UCHealth Today\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/uchealthorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2021-06-08T21:47:47+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-01-17T20:08:53+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2021\/06\/08152657\/croppedFNDphoto.jpgtiny.jpg\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Tyler Smith\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@uchealth\" \/>\n<meta name=\"twitter:site\" content=\"@uchealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Tyler Smith\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\\\/\"},\"author\":{\"name\":\"Tyler Smith\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#\\\/schema\\\/person\\\/98c85c0e40c4933eedcec2cd054f349d\"},\"headline\":\"Functional neurological disorder straddles two worlds: neurology and psychiatry\",\"datePublished\":\"2021-06-08T21:47:47+00:00\",\"dateModified\":\"2025-01-17T20:08:53+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\\\/\"},\"wordCount\":2252,\"publisher\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/uchealth-wp-uploads.s3.amazonaws.com\\\/wp-content\\\/uploads\\\/sites\\\/6\\\/2021\\\/06\\\/08152657\\\/croppedFNDphoto.jpgtiny.webp\",\"keywords\":[\"Behavioral health\",\"Neurology\",\"Neurosciences outcomes\"],\"articleSection\":[\"Innovative care\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\\\/\",\"url\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/functional-neurological-disorder-straddles-two-worlds-neurology-and-psychiatry\\\/\",\"name\":\"Functional Neurological Disorder straddles two worlds - 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