by Eoin Roe
I am seeing more and more patients who have been given a diagnosis of Functional Neurological Disorder (FND). It is given to those presenting with neurological symptoms like gait and balance issues, new speech problems, occasional paralysis of limbs, dysautonomia (problems with sympathetic /parasympathetic tone) and other neurological symptoms, which can be debilitating, causing fatigue, anxiety and an inability to concentrate. This is particularly significant for younger sufferers, as it can make school difficult and many are unable to attend.
From a medical point of view these symptoms are considered serious but often patients given this diagnosis have normal MRI findings and a reason for developing these symptoms is unclear.
One area that I focus on is the possibility that neuroinflammation is causing these symptoms, as neuroinflammation is hugely problematic but does not show up on blood tests, MRI or other commercially available scans.
What is neuroinflammation? When people think about the brain and what makes it work, the first thought is usually about neurons, which send electrical signals from the brain to instruct the body to function. There are also a number of specialist immune cells in the brain, which are incredibly important to this process. I would like to focus on one type of specialist immune cell called a microglial cell. These are dendritic cells, meaning they have arms and can move around the brain and their job is to clear debris from neurons and support how they function. When microglial cells become activated, either by an injury like concussion or after an infection in the upper respiratory tract of the inner ear, they switch from their normal role, and some become inflammatory and others anti-inflammatory. After this transformation they are unable to switch back to their normal resting state. When these cells become inflammatory they have a negative effect on how neurons work.
The mechanisms of neuroinflammation are influenced by diet, nutrition, lifestyle and combined with specific neurological exercises an important part of recovering from FND.
There are two reasons why diet might be important. The first is to do with energy and the other the triggering of the immune system. The brain needs a steady supply of glucose and an abundance of oxygen – without these it struggles to function well, even when we are in good health. So a steady glucose supply and abundance of oxygen becomes very, very important for those with FND. Neurons require a large amount of energy to function and it gets this from stable blood glucose – what this means in practice is that skipping meals and eating a diet that is high in processed foods and sugars makes blood sugar unstable, making it very hard to recover.
The second reason is to do with immune responses. The immune system throughout the body uses signalling molecules. When you get an infection, these signalling molecules will start to circulate in your system and prime or up-regulate certain responses and, if the microglial cells in your brain are in a primed state, this can switch them into an inflammatory mode and make the symptoms of FND worse. Infections are not the only trigger for the immune system – certain chemicals, airborne toxins and even certain foods can trigger responses in the immune system.
Specific exercises may also help. The human body is an amazing self healing organism. I am sure many of you have had a broken bone or had stitches after an operation or injury. If you have broken a bone, part of your recovery will include exercises to get the joint moving properly to help return to full range of motion and function. The same is true of the brain. It is possible to use functional neurology testing to get an idea of which parts of the brain are affected and rehab with focused exercises that support these areas, improving blood flow and strengthening neurons. It is important when working with someone who has FND to get this right, as if you over-stimulate a particular area you can make symptoms worse, so a very measured approach, increasing exercises over time, has the best result.
Eoin Roe is a chiropractor and functional neurology specialist working is Skibbereen. Get in touch through the website www.roehealth.ie or call and leave a message on 028 62081.
