Nothing is easy but everything is possible



Using a psychosocial approach will restore the connection between body and psyche. Communication is of particular importance in this exercise. Being able to explain to the patient the current knowledge about the regulation of functional neurological disorders, the body has lost its ability to transmit the right signals. Bring the idea that part of the problem is due to a neuronal circuit problem, which makes it necessary to rearrange the way signals are transmitted to the brain. Inform that this redevelopment will take time. Also explain the phenomenon of disorder amplification syndrome, the influence of stress, the fact that "head" problems (especially emotions) can manifest themselves in the body through these functional disorders. Tell the patient that we believe him when he complains of his symptoms, that the cause is not totally clear, but that we know how to reduce them if we do not know where they come from; it is an essential step to put an end to the sometimes compulsive search for a classic cause of disease. Offering the patient to work to reduce the symptoms rather than continuing to look for the cause helps, in general, to initiate treatment. Talk at the outset about the influence of psychological aspects on disorders, and therefore the need to work in collaboration between neurologists and psychiatrists.

It is necessary to identify within each care network a "conductor" who will centralize the care, ensure communication between the patient and the multidisciplinary team of caregivers as well as with the entourage. For this, trust is important and sometimes slow to acquire given the often difficult journey of patients in the healthcare system. The organization of networks is a key element to reduce blockage, harmonize messages and contain these situations that are often heavy. The referrer can be a primary care physician, specialist, psychiatrist or caregiver who plays a central role in the care and in whom the patient and his entourage trust.

It is the return to a normal life that will lead to an improvement in functional neurological disorders and not the other way around. Several studies show that the return to normal activity allows the restoration of compromised function and a regression of functional disorders. Propose the approach: sleep, sport (activity), socialization and work, which will break the infernal spiral and bring normality back to the lives of these patients and improve the symptomatology. Sport and work must be implemented gradually and in stages. Prior contact with the company is essential to explain the problem and work together on a suitable recovery.

Introduce physical therapy for disabling functional disorders to recondition patients, which generally decreases complaints and allows functional recovery that promotes a return to normal activities. The physical approach and the rebalancing of structures allows patients to overcome disabling pain in order to return to the path of physical activity. Sometimes, failing to reduce the pain, it allows you to experience that movement is still possible. Psychomotricity brings a possibility to make links between sensoriality, emotions and functionality, through meaningful activities for patients. The latter appreciate the introduction of a bodily approach in response to their discomfort that they feel on a physical level only. The awareness of caregivers to the problem of functional disorder is necessary to optimize these treatments because it allows them not to judge the patient and to help him verbalize his feelings in relation to the symptoms, which often represents the first beginning of a "body-head" bond.

Use psychocorporeal approaches and complementary medicines. Many approaches such as yoga, hypnosis, biofeedback, acupuncture, meditation to name a few, have shown effectiveness in the field of regulation of functional neurological disorders. Some experiments with hypnosis have shown that over the course of the sessions the patient discovers "first times" without symptoms or perception of these symptoms and that these techniques allow him a beginning of "control" on his disease.

Psychological follow-up is essential to work on the identification and treatment of psychological suffering, whether personal or family. Individual and/or family psychotherapy makes it possible to make sense of the symptoms by situating them in the history of the patient and his relatives. For too long, psychological follow-up has been the only response given by the medical profession to a functional disorder, when all investigations were normal. However, at first, the proposal of a psychological approach is rarely acceptable for the patient who perceives only the bodily component of his symptoms. The feeling of incomprehension can lead to the breakdown of follow-up and the medical desert. It is in the context of body therapies that the first links between the body and emotions can be forged, sometimes very slowly, until the patient accepts psychological care in addition to (and not instead) body therapies. Often deeply affected by the symptoms and disabling problem of TNF, families must be supported.