From the Guidelines
The treatment for functional neurological disorder (FND) should prioritize a multidisciplinary approach, focusing on education, physical therapy, psychological treatments, and occupational therapy, with the goal of improving symptoms, function, and quality of life, as supported by the most recent consensus recommendations 1. The cornerstone of treatment is education about the condition, helping patients understand that FND is a real neurological disorder where the brain is not functioning properly rather than a psychological issue or malingering.
Key Components of Treatment:
- Education about the diagnosis and symptoms
- Physical therapy, particularly for movement symptoms, with specialized rehabilitation protocols focusing on retraining normal movement patterns and gradually increasing activity levels
- Psychological treatments, especially cognitive behavioral therapy (CBT), to address underlying stress, trauma, or emotional factors that may contribute to symptoms
- Occupational therapy to help patients regain independence in daily activities
- Speech therapy for those with speech or swallowing difficulties
- Medications may be prescribed to manage specific symptoms, such as antidepressants, antipsychotics, or anticonvulsants, though medication is not the primary treatment
Important Considerations:
- Treatment should be tailored to each patient's specific symptoms and needs
- Early intervention and patient engagement in therapy are crucial for success
- Addressing underlying psychological factors is essential for improving symptoms and quality of life
- A biopsychosocial aetiological framework should guide occupational therapy treatment for FND, with a focus on education, rehabilitation within functional activity, and the use of taught self-management strategies 1
- The use of compensatory aids and techniques should be avoided in the acute phase or when undergoing active rehabilitation, and the use of splints or devices that immobilize joints should be avoided 1
From the Research
Treatment Approaches for Functional Neurological Disorder
The treatment for functional neurological disorder (FND) typically involves a multidisciplinary approach, addressing both neurological symptoms and underlying psychological factors. Some of the treatment options include:
- Rehabilitative therapies, such as physical therapy, occupational therapy, and speech and language therapy 2, 3
- Psychological therapies, including cognitive behavioral therapy (CBT) 3, 4
- Multidisciplinary care, involving a team of healthcare professionals, including neurologists, psychologists, and therapists 2, 5
- Individualized treatment plans, tailored to the specific needs of each patient 2, 5
Therapeutic Interventions
The optimal timing of specific therapeutic interventions is crucial in the treatment of FND. Some of the therapeutic interventions that have shown promise include:
- Physiotherapy, to address motor symptoms such as weakness and tremors 3, 5
- CBT, to address underlying psychological factors and promote recovery 3, 4
- Neuromodulation, to regulate brain activity and improve symptoms 5
- Pharmacotherapy, to manage symptoms such as pain and anxiety 5
Remote Delivery of Therapies
Remote delivery of therapies, such as CBT, has shown promise in increasing access to treatment for patients with FND. Some of the remote delivery options include:
- Workbooks and online guides 4
- Internet-guided CBT and app-based CBT 4
- Teletherapy, which allows patients to receive therapy remotely 4
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of FND are crucial in promoting recovery and improving outcomes. A strong therapeutic alliance and patient confidence in recovery have also been shown to improve outcomes 5.