What are pseudoneurological conditions?

Pseudo-neurological conditions are illnesses that mimic a wide range of diseases of the nervous system, but are not caused by any organic disorder.

In the classical form they are truly psychosomatic (caused or aggravated by mental conflict) and reflect the close links between the brain and the peripheral nervous system, and the interplay between mind and body.

They are not “put-on”, and affected individuals should not feel they are being branded as frauds. Although it may be difficult to distinguish some pseudoneurological conditions from feigned illness, in genuine cases the symptoms are as real and disabling as those cause by organic disease.

There is a second group of pseudoneurological conditions, known as pseudosyndromes, in which the symptoms of one disorder produce effects which mimic those of another unrelated disease.

What are the symptoms and signs of pseudoneurological conditions?

• Seizures

• Pain, especially headaches

• Weakness or paralysis

• Numbness or tingling

• Spasms, tics or tremors

• Abnormal posture

• Gait abnormalities

• Disturbances of vision

• Loss of taste and smell

• Loss of voice

• Delirium

• Loss of memory

• Dizziness or vertigo

What are the causes of pseudoneurological conditions?

Pseudoneurological conditions are thought to arise by a psychological mechanism called conversion (previously known as hysteria).

Individuals may be vulnerable because they are facing unresolvable stress, for example due to financial, marital or school problems, or sexual abuse.  There is often a real but minor underlying physical problem, such as muscle strain from an accident.

Typical sufferers are not able to acknowledge how difficult their personal problems have become and so the body reacts by converting the stress into a symptom.  This relieves their conscious or unconscious anxiety, which is the primary gain.

There may also be a secondary gain in that, for example, an individual is able to avoid an unmanageable home or work situation, gets compensation or other financial benefit or receives medical attention.

However, individuals are rarely seeking these gains deliberately or consciously but genuinely want to become well.

There may be a genetic link since 20% of patients have a relative with similar problems.

Pseudosyndromes are much rarer.

They include:

• Pseudo-tumor: water on the brain simulating a brain tumor.

• Pseudo-dementia: severe depression simulating dementia

• Pseudo-poliomyelitis: a spinal artery block simulating polio.

• Pseudo-tabes: diabetes simulating syphilitic disease of the spinal cord.

• Pseudo-parkinsonism: a frontal lobe disorder simulating Parkinson’s disease.

How are pseudoneurological conditions diagnosed and treated?

Psychosomatic pseudoneurological conditions may be partly diagnosed by a full examination that rules out other organic conditions, or by a neuropsysiological investigation by means of CT (computed tomography) scanning, or MRI (magnetic resonance imaging), to produce an image of the brain.  Sometimes the clinical signs do not fit in with the actual structure of the nervous system.  For example, there may be facial pain that extends into the angle of the jaw.  This cannot occur organically as the angle of the jaw is supplied by a nerve from the neck and not in the face.

Some psychosomatic pseudo-neurological conditions strike much more suddenly and dramatically than true neurological disease.  In some cases, there may have been an earlier episode that went into remission spontaneously.

There are also aspects of the disorder which a psychiatrist is skilled in identifying.  If a patient is advised to see a psychiatrist, this does not imply the doctor is failing to take the condition seriously, or is suggesting the individual is mentally unstable.  The doctor is just trying to get a complete picture of the sufferer’s difficulties in order to advise on the best course of treatment.

Treatment is begun only after a full investigation.  The patient is assured that the condition is not imaginary and is being taken seriously.  The condition may be treated by psychotherapy (psychological therapy), to help the sufferer gain insight into, a control of, the difficulties that have been converted into symptoms. The sufferer may also begin medication such as an antidepressant.  Treatment should not be delayed; the longer the condition has lasted the more difficult it is to treat.

In organic pseudosyndromes the underlying cause must be treated.

When should I see my doctor?

Any of the symptoms and signs listed above warrants prompt and full investigation.  Neither the sufferer nor the doctor should assume a condition is pseudoneurological until this has been proven.

What will the doctor do?

The doctor will note the history of the complaint and the sufferer’s family history and ask about current social and emotional circumstances. A nervous system examination will be carried out to look for positive signs of organic disease.

The sufferer may be referred to a neurologist for a more detailed examination and specific tests.  Doctors are aware of the hazards of mistakenly diagnosing a pseudo-neurological condition and will not make the diagnosis lightly.

Are pseudo-neurological conditions dangerous?

If a correct diagnosis is not made, inappropriate medications may be given, or unnecessary investigation or surgical operations carried out. Although pseudo-neurological conditions can cause extreme disruption to the quality of life, the majority of them are less dangerous than the neurological disorders they mimic.

Individuals with pseudo-neurological conditions need to keep an open mind concerning the personal pressures, which may underline the problem.