Functional Neurological Disorder (FND): Brain-Body Disconnect Explained and Treated

Overview

The podcast explains functional neurological disorder (FND) through Kyla's experience, tracing the shift from viewing such symptoms as anxiety or hysteria to recognizing FND as a real, treatable brain body condition. It highlights how diagnosis has evolved away from diagnosis of exclusion toward identifiable signs and the importance of patient belief and integrated care.

• FND bridges neurology and psychiatry by showing disorders of brain body connection that may not involve visible brain lesions.
• The Hoover sign and related tests reveal that basic motor pathways are intact even when movement is not under voluntary control.
• Care is multidisciplinary, combining education, brain retraining, physical and occupational therapy, and psychotherapy such as cognitive behavioral therapy.
• Kyla’s journey demonstrates the value of peer support, mindfulness, and creative expression in healing and advocacy.

Introduction and core idea

The podcast from Short Wave, NPRs science program, centers on functional neurological disorder, a condition where patients experience genuine neurological symptoms such as tremors, dizziness, or weakness even when there is no structural brain damage. The episode uses Kyla Madonna Kenneys story, which begins with a severe one sided migraine and tremors, to illustrate how FND can be misdiagnosed as anxiety or sinus problems before a clinician understands the underlying brain body miscommunication. The host, Emily Kwong, and the guest, Dr. David Perez of Massachusetts General Hospital, walk listeners through the current understanding of FND as a condition that sits at the intersection of neurology and mental health, challenging the traditional dualism in medicine and society that separates mind and body.

What is FND and why it matters

The central idea is that FND represents a “final common pathway” for diverse triggers that disrupt movement and sensation. The brain software may be glitchy, yet the hardware remains intact. This reframes symptoms as legitimate brain body states rather than symptoms rooted in willful faking or purely psychiatric problems. The podcast emphasizes that FND is not rare; it is common enough to be a frequent reason people visit neurologists, but it remains often missed or misunderstood by clinicians who rely on old diagnostic frameworks. The episode notes that FND was added to the DSM in 2013, marking a shift toward concrete diagnostic criteria instead of a cascade of exclusions, and it acknowledges that the triggers can include physical injury, not just psychological stressors.

Historical context and diagnostic evolution

The conversation covers the long history of terms used to describe FND, including hysteria, conversion disorder, medically unexplained symptoms, and psychogenic illness. It explains how neurology and psychiatry historically separated, leading to a gap in care for patients who did not fit neatly into either discipline. A pivotal shift involved recognizing signs that enable clinicians to diagnose FND with confidence instead of treating it as a mystery. Dr. Mark Halletts work is highlighted as instrumental in validating patient experiences and moving away from dismissive attitudes toward patients who report loss of control over movements. The Hoovers sign and other clinical tests illustrate how patients can have intact reflex pathways while voluntary movement is compromised, underscoring the brain body disconnect central to FND.

The Hoover sign and brain networks

The Hoover sign test demonstrates a key principle of FND: when a patient with one leg weakens under direct testing, the other leg can regain strength when attention is directed to the stronger leg. This reveals that motor pathways are functionally intact in both legs, while networks involved in motor control, agency, and sense of action may be misdirected or hijacked. The podcast ties this to research showing abnormal activity in brain regions responsible for self agency and action authorship, such as the right temporoparietal junction. The host and Dr. Perez discuss how functional disruptions in brain networks can lead to a mismatch between intention and movement, while the basic wiring remains sound. This framing helps patients and clinicians understand that symptoms have a neural basis even in the absence of structural lesions.

Risk factors and misconceptions

The discussion clarifies that lifetime experiences such as childhood maltreatment are not universal risk factors for FND, addressing a common misconception. The podcast emphasizes a biopsychosocial perspective that considers biological, psychological, social, cultural, and spiritual dimensions. It also notes that while psychological factors can influence FND, the condition is not simply a psychiatric illness nor a purely physical disease, but a complex brain body disorder that deserves integrated care.

Diagnosis, treatment, and care pathways

The episode outlines best practices for caring for people with FND. The first step is education for patients and families. An expert neurology assessment paired with mental health context is ideal, followed by brain retraining and motor retraining through physical, occupational, and speech therapy. Cognitive behavioral therapy, particularly tailored to FND, is commonly used alongside physical therapies. The podcast emphasizes skills based psychotherapy and patient engagement with peer groups, illustrating how sharing experiences can improve outcomes. Kyla shares that meditation, cognitive behavioral therapy, and understanding her triggers have helped her manage symptoms. She also uses her musician identity to share her story through song, giving voice to a condition that was once shrouded in mystery and disbelief.

Kyla's journey and takeaways

The narrative of Kyla demonstrates that recovery can be gradual and highly individual. The combination of meditation, CBT, and self awareness—paired with social support and creative expression—can create a practical path forward for many individuals with FND. The podcast ends with a hopeful message about believing patients and providing multidisciplinary care that honors brain body connections rather than splitting symptoms into rigid categories.

Implications for medicine and society

Overall, the podcast argues that FND challenges the artificial divides that often hinder patient care. By acknowledging the brain as an active agent in symptom generation and recovery, clinicians can improve diagnosis, reduce unnecessary procedures, and offer therapies that address both neurological and psychological dimensions. The episode calls for ongoing research into brain networks involved in agency and for expanding access to comprehensive, multidisciplinary treatment programs that support patients in daily life and in expressing their experiences publicly.