MONTREAL – A novel approach to treating Functional Neurological Disorder (FND), a condition impacting the brain’s ability to control movement and bodily functions, is gaining traction at the Center hospitalier de l’Université de Montréal (CHUM). For years, FND patients ofen faced dismissal or misdiagnosis, but a specialized clinic established at CHUM in 2017 is pioneering a rehabilitation model focused on retraining the brain-a strategy now showing promising results for a majority of those affected. This shift in understanding and treatment offers renewed hope for individuals experiencing debilitating symptoms without detectable structural neurological damage.
For years, patients presenting with paralysis or seizures despite no apparent neurological cause were often misdiagnosed, leading to delayed and ineffective care. Now, a growing number of clinicians are recognizing these symptoms as manifestations of Functional Neurological Disorder (FND), a condition where the brain’s ability to send and receive signals to the body is disrupted – not due to structural damage, but due to a software glitch in the brain’s operating system.
Physical therapist Pierre-Luc Lévesque, while working at Notre-Dame Hospital, began noticing a pattern of puzzling cases. “We initially thought it was simulation or attention-seeking behavior. But we were wrong. These people were genuinely suffering,” he recalls.
Further investigation, and discussions with neuropsychiatrist Laury Chamelian, led him to a 2013 consensus statement from experts in the United Kingdom recommending physiotherapy as a treatment for FND. Upon arriving at the CHUM (Centre hospitalier de l’Université de Montréal) in 2017, Lévesque established a committee with Drs. Bérubé and Chamelian. Six months later, the CHUM’s Functional Neurological Disorders Clinic – the first of its kind in Quebec – began accepting patients. The clinic’s interdisciplinary team, comprised of neurologists, psychiatrists, physical therapists, occupational therapists, and neuropsychologists, focuses on restoring lost functions rather than simply eliminating symptoms.
In 2021, the clinic officially adopted the “predictive brain” model to understand FND. This shift moved away from older theories of conversion disorder. The change has yielded positive results. “Since then, patients have a better understanding of their condition, are more accepting of the diagnosis, and regain their abilities in 70% of cases. Sometimes, simply understanding the mechanisms of the disorder is enough to trigger improvement,” observes Dr. Bérubé.
Lévesque explains that rehabilitation aims to give the brain the correct “instruction manual” for the body. “We see ourselves as guides,” he says. His interventions center on redirecting attention, reprogramming automatic movements, and demonstrating real capabilities – such as walking backward, playing catch, or using a metronome. When attention shifts away from the symptom, the body regains its freedom. “We show patients how to control their symptoms. Each success builds their confidence. The patient then becomes the agent of their own rehabilitation – what we call the concept of agency,” he explains.
This approach represents a significant advancement in understanding and treating FND, offering hope to patients who previously faced frustration and misdiagnosis. Recognizing FND as a genuine neurological condition, rather than a psychological one, is crucial for providing effective and compassionate care.
