Behavioral Medicine and Clinical Psychology

Mia and Functional Neurologic Disorder (FND)

After a hard fall at soccer practice last September, Mia Allard suffered a concussion and whiplash. 

Ten days later, the side effects—including extreme neck pain and repeated loss of consciousness—remained. Her parents, Mark and Gisela, were worried. 

“Every time she sat up, she would pass out completely—fully limp and out for 20 to 30 minutes,” explained Mark. “Numerous diagnoses were at play [but] all the results came back inconclusive and showed Mia as a healthy girl.”

As a result, doctors in their hometown of Dayton advised patience, and said rest and time would lead to Mia’s gradual recovery.

Mia and her parents, however, needed answers. Why was Mia passing out? Why were tests showing the 13-year-old as “healthy” when there was ample evidence to the contrary?

They transferred Mia to Cincinnati Children’s to find out.

Upon arrival, a team of experts from across the hospital examined Mia and conducted tests. First, doctors asked the family questions. Then, doctors asked each other questions.

The collaborative team approach had a strong effect on the family. It was not only comforting to witness the high level of care; it also provided the much-needed confidence that Mia would get better.

“They really listened to our story and came up with an actionable plan that they briefed us on in advance,” said Gisela. “After they got results from each test, each doctor came back to talk to us to discuss their thoughts and the next steps. We really felt the love from the staff at Cincinnati [Children’s].”

Finally, Mia had a conclusive diagnosis: functional neurologic disorder (FND).

What is Functional Neurologic Disorder (FND)? 

David M. Ritter, MD, PhD, part of the initial team that treated Mia, explained that FNDs are quite common but often misunderstood. The exact cause is unknown, but FNDs can include a wide range of problems where patients have difficulty in neurologic functioning unrelated to a specific neurologic disease.

These problems can impact how the brain sends and receives signals and how the body responds to different movements. 

“It is a subconscious reaction to signals coming into the brain that results in the patient losing function,” said Dr. Ritter.  

Most often, this loss of function includes pain or numbness, inability to move arms or legs, or having episodes like seizures or uncontrolled movements. 

“In Mia’s situation, the sitting up/standing caused a passing out feeling which caused her brain to functionally be unable to control her muscles, even though on our testing her brain and muscles had the ability to work normally,” explained Dr. Ritter. 

FND is not the same as a neurologic disorder causing symptoms. This difference can often cause confusion and frustration for families and patients. 

“Many patients come to us being told they are ‘making up things,’ or report ‘the doctors don’t know what is going on.’ This is because, unlike neurologic disorders, there is no specific part of the nervous system that is not working correctly, and thus their symptoms may not make sense unless you know about FND,” said Dr. Ritter.

Treatment Options for Mia Following FND Diagnosis

For her treatment, Mia worked with various neurology team members, including experts in behavioral medicine and clinical psychology, as well as occupational and physical therapists.  

The FND diagnosis proved to be the crucial first step for Mia on her road to recovery. 

“When Mia was told about this [FND] condition, it was almost like it gave her confidence that nothing was wrong with her,” said Gisela.

By meeting regularly with neurology team members, Mia made great progress and, within a few days, was able to sit up and stand without passing out. 

Her initial progress led to increased physical therapy, then walking, and eventually her release from the hospital. Once home, Mark and Gisela slowly reintroduced Mia’s workout routine over the next several months to build up her strength. 

Although Mia continued to have a few episodes of passing out, the family stayed in close contact with Dr. Ritter and the behavioral medicine and clinical psychology team via telehealth visits. 

Maintaining a regular exercise routine also helped, and today Mia says she is “almost 100% back to normal” as she plans an eventual return to the soccer field. 

“I’m really ready to get back,” said Mia. “However, I’m going to sit this spring season out. Soccer is my passion, but I will run track and field to stay in shape and hope to get back into soccer in the fall.” 

She also hopes that other young athletes recovering from brain-related injuries will listen to her advice. 

“Even when the test results show you are fine, sometimes your brain takes time to heal,” said Mia. “I didn’t like being in the hospital, but I will not let this get in my way of playing sports, as it could happen to anyone.”

(Published March 2022)