From the Guidelines
Functional neurological disorder (FND) treatment should prioritize a multidisciplinary approach, incorporating psychotherapy, occupational therapy, and physical therapy to address the complex interplay of psychological, social, and physical factors contributing to the disorder. The most recent and highest quality study, 1, suggests that cognitive-behavioral therapy (CBT) principles can inform therapy, even without formal CBT training, by helping patients notice and challenge unhelpful thoughts.
Key aspects of FND treatment include:
- Addressing psychosocial predisposing and perpetuating factors, as outlined in 1
- Incorporating principles from CBT to aid treatment, as suggested in 1
- Utilizing occupational therapy to enable participation in daily activities and improve function, as recommended in 1 and 1
- Implementing strategies to manage dissociative (non-epileptic) seizures, such as developing a seizure plan and using sensory grounding techniques, as described in 1
A comprehensive treatment plan may involve:
- 12-16 weekly sessions of CBT or other psychotherapy
- Occupational therapy to address functional limitations and promote participation in daily activities
- Physical therapy to assist with functional movement disorders
- Patient education to improve understanding of the disorder and its management
- Medications, such as antidepressants, to address comorbid conditions like anxiety and depression
Treatment success depends on a multidisciplinary approach, involving neurologists, psychiatrists, psychologists, and therapists working together, with early intervention generally leading to better outcomes, as suggested in the example answers.
From the Research
Treatment Options for Functional Neurological Disorder (FND)
- Rehabilitative interventions, such as physical and occupational therapy, are considered treatments of choice for functional motor symptoms 2
- Psychotherapy, including cognitive behavioral therapy (CBT), is an emerging evidence-based treatment for FND, with studies showing significant reduction in seizures and other psychiatric symptoms 2, 3, 4
- Nocebo Hypothesis Cognitive Behavioral Therapy (NH-CBT) has shown promising results in treating Functional Neurological Symptom Disorder (FNSD), with significant between-group effects in favor of NH-CBT for several secondary outcomes, including motor symptoms and mobility 5
Diagnosis and Management
- Early diagnosis and access to evidence-based treatments can promote recovery in patients with FND 2
- A comprehensive explanation of the diagnosis and respectful communication with patients are critical first steps in enhancing engagement, adherence, and treatment outcomes 6
- Thorough psychiatric assessment can identify relevant biopsychosocial and predisposing, precipitating, and perpetuating factors, as well as assess comorbid psychiatric disorders, to inform a treatment plan 4
Research and Future Directions
- More research is needed to individualize treatments and develop novel interventions for FND, as responses to treatment can be heterogeneous 2
- A treatment research agenda has been proposed to aid in advancing the field and developing effective treatments for patients with FND 6
- Neuroimaging studies suggest that FND may occur in the context of alterations within and across sensorimotor, emotion regulation/processing, cognitive control, and multimodal integration brain systems, requiring further replication and investigation 3