Sintomas Neurológicos Funcionais e Dissociativos: um guia para pacientes

 

Hemi

Treatment of Tremor / Spasms

Not much is known about what the best treatments are for patients with functional movement disorders like tremor and spasms

 

This section is based mainly on the authors own experience in trying to assist many  patients with functional movement disorders to get better.

 

If you haven't read them yet, have a look at these sections before you read on:

 

1. Tremor, Spasms and Walking Problems

 

Its really important to understand that this symptoms are common, does not mean you are going mad or 'losing it', and are potentially reversible without medication.

 

2.  Understanding the diagnosis

 

Its essential that you feel the doctor has looked in to your case properly and come to the correct diagnosis.

 

3. Physiotherapy and exercise

This explains some basic principles behind rehabilitation and exercise for functional symptoms including weakness, pain and fatigue

 

4. Psychology? I'm not crazy

 

If your doctor has referred you to a psychologist or psychiatrist you may be wondering why. Read this section to help you understand this

 

 

 

 

 

 

We are still learning more about what kinds of treatment work best for patients with functional weakness.

 

 

Understanding it

 

It can be suprising how much impact simply receiving a clear and understandable explanation for the symptom can have. Often patients with functional movement disorder may have gone months or even years without a diagnosis (or sometimes with an alternative diagnosis like parkinsons disease).

 

It can take a long time to 'get your head' around being diagnosed with a functional movement disorder. For patients that do start to feel better, doing this seems to be an important part of it

 

Seeing how it fits in with all your other symptoms can also be an important part of understanding it. It can help to understand that your weakness is one symptom among many (usually pain, fatigue and sleep disturbance) and that you have one illnes swith many symptoms, not many symptoms caused by different diseases.

 

For this reason, it is probably the case that some of the treatments that are proven to be effective for patients with chronic fatigue syndrome/ME and chronic pain are also helpful for patients with functional movement disorder.

 

these include

 

1. Graded exercise / physiotherapy

 

2. Cognitive behavioural therapy

 

3. Medication to help pain and sleep

 

 

Specific things that come up in relation to functional movement disorder

 

Intermittent movement disorder

Some patients with tremor experience 'bouts' of tremor. These episodes may be preceded by dissociative symptoms. Although patients with this do not black out, the advice on treatment and learning to avert attacks may be similar to that for dissociative seizures. Have a look at the two treatment pages for dissociative seizures and see if anything applies to you.

 

 

Think about how variable it is

Variability is a common feature of many functional symptoms. If you think about it, its one reason why the diagnosis of functional symptoms makes sense. If there was structural damage to the nervous system, the symptom might fluctuate a bit but not dramatically as it can do with functional movement disorders.

 

There are several reasons why functional movement disorders can vary in severity:

 

1. At times of greater fatigue

 

2. At times of greater pain

 

3. When you are thinking consciously about movement

 

This last one is worth some thought. You may have noticed that the more attention you pay to your movements the worse they get.

 

Try, as much as possible, not to think about your movements. Remember that with functional movement disorder you are trying to regain control of a limb that may not feel completely like 'yours'.

 

Sometimes patients report that having their tremor or abnormal posture feels 'natural' whereas having a limb that is in the normal position or still feels unnatural.

 

These movement may feel 'natural' but they are not. You may need to train your brain so that the normal position starts to feel natural again. Read Anna's Story on the Cases page for an example of this.

 

Try these specific things to see if they can help your movements. these may be especially useful if your movements are worse when you walk:

 

1. Try humming a tune or singing a song (in your head if you need to!) while walking. Has this made it easier to walk?

 

2. Try walking backwards if you have difficulty walking. Walking backwards is a different 'program' in the brain and you may be surprised to find that its easier than walking forwards.

 

3. Running. For patients that are able, sometimes a slight jog makes it easier to move. This is a bit like someone with a stutter who has problems speaking but can sing normally.

 

 

Other treatments

 

It may be worth trying hypnosis. Sometimes under hypnosis, normal movements in a limb with a fixed dystonia can occur again. Tremor may improve and you may be able to learn slef hypnosis to practice at home

 

Occasionally patients with fixed dystonia can benefit from sedation with a general anaesthetic. This allows examination for any contractures. If this is handles correctly it can encourage normal movements which the patient has not experienced for a long time. This should only be carried out if your doctor has experience with this technique. It is not a 'cure-all' for fixed dystonia.

 

 

 

 

 

 

 

 

 

 

Learning to overcome functional movement disorders ...

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