What happens in the body
In conversion disorder, it is not the transmission of signals along the nerves that suffers, but the control of movement at the level of brain networks: a command is formed, but is not implemented in the usual way, because attention and expectation rearrange the work of motor areas. Therefore, the symptom may disappear when a person is distracted, and return when attempting conscious control. This explains the apparent inconsistency of the picture, which previously caused distrust among doctors. Today, such mechanisms are well described, and the diagnosis is made on the basis of positive clinical signs, and not simply because the images are clear.
- It's the brain networks that are disrupted, not the nerve structure
- Symptoms are involuntary, the person has no control over them
- Manifestations change with distraction
- Images and tests remain normal
- Diagnosis is made based on positive signs
How it manifests itself
Manifestations are varied and often mimic serious neurological diseases. Weakness and paralysis of the limbs, trembling, unusual gait, sudden loss of voice, sensation of a lump in the throat, numbness of the “gloves and socks” type, and visual disturbances occur. A separate form is functional seizures, externally similar to epileptic ones, but without changes on the electroencephalogram. Symptoms usually begin acutely, may fluctuate throughout the day, worsen in stressful situations, and decrease when the person is doing something exciting.
- Weakness or paralysis of an arm or leg
- Gait and balance problems
- Tremor, involuntary movements
- Functional seizures without changes on EEG
- Loss of voice, speech impairment
- Numbness, decreased sensitivity
- Visual impairment
Why does it occur
Most often, the disorder develops in people who live for a long time in a state of overload or have experienced a difficult event: loss, violence, accident, conflict in the family. The triggering moment is a physical injury, surgery, infection or panic attack - the body seems to “fix” the disturbed motor image. Anxiety and depressive disorders, chronic pain, and childhood traumatic experiences increase the risk. It is important to understand: the absence of an obvious psychological cause does not negate the diagnosis; in about a third of people, the connection with stress cannot be traced.
- Acute or chronic stress
- Psychotrauma, including long-term
- Physical injury or illness as a triggering factor
- Anxiety and depressive disorders
- Chronic pain and fatigue
- Panic attacks
Diagnostics
The doctor conducts a neurological examination and uses special tests that show that muscle strength and coordination are intact, although voluntary movement is impaired. At the same time, conditions requiring emergency care are excluded: stroke, multiple sclerosis, myasthenia gravis, epilepsy. For this purpose, MRI of the brain and, if necessary, spinal cord, tests are prescribed, and in case of attacks, electroencephalography, preferably with video monitoring. If the picture is typical and the tests are positive, repeated examinations are not needed: an endless search for the disease only intensifies the symptoms.
- Neurological examination with positive tests
- MRI of the brain
- Electroencephalography, during attacks - video-EEG
- Blood tests to exclude metabolic causes
- Assessing anxiety, mood and sleep
- Avoiding unnecessary repeat examinations
Treatment and recovery
The first and most important step is to clearly explain the diagnosis: the symptoms are real, the mechanism is known, the condition is reversible. Next comes motor rehabilitation with a physical therapist who uses distraction and automatic movements to restore normal motor patterns. For functional seizures, they are taught to recognize warning signs and grounding techniques. Psychotherapy helps to work with stress, anxiety and traumatic experiences. Medications are prescribed only for comorbid anxiety or depression; There is no separate drug for conversion disorder.
- Clear explanation of the diagnosis to the patient and family
- Motor rehabilitation and physical therapy
- Speech therapy assistance for speech and voice disorders
- Psychotherapy, work with trauma and anxiety
- Training in techniques for functional seizures
- Treatment of comorbid depression and anxiety