From the Guidelines
The first line of treatment for functional neurological disorder (FND) should be a multidisciplinary approach that includes education, occupational therapy, and psychological interventions such as cognitive behavioral therapy (CBT), as this has been shown to lead to better outcomes and significant improvement in symptoms over time. This approach is supported by recent studies, including a 2020 consensus recommendation for occupational therapy in FND, which emphasizes the importance of a biopsychosocial aetiological framework and the use of taught self-management strategies 1.
Key Components of Treatment
- Education about the condition to reassure patients that FND is a real medical condition that can improve with appropriate treatment
- Occupational therapy to help patients retrain normal functional activities and manage their symptoms
- Psychological interventions, such as CBT, to address underlying stress, trauma, or emotional factors that may contribute to symptoms
- Physical therapy to retrain normal movement patterns
Importance of Early Intervention
Early intervention with this multidisciplinary approach has been shown to lead to better outcomes, with many patients experiencing significant improvement in their symptoms over time. A 2021 study on the management of functional communication, swallowing, cough, and related disorders also highlights the importance of incorporating principles from CBT to aid treatment of FND, by helping patients notice and challenge unhelpful thoughts 1.
Treatment Goals
The goal of treatment is to help patients understand that their symptoms are not imagined but result from a problem in how the brain processes and sends signals to the body, and to provide them with the tools and strategies needed to manage their symptoms and improve their quality of life. By prioritizing a multidisciplinary approach that includes education, occupational therapy, and psychological interventions, healthcare providers can help patients with FND achieve significant improvement in their symptoms and overall well-being.
From the Research
Functional Neurological Disorder Treatment
The first line of treatment for functional neurological disorder (FND) typically involves a multidisciplinary approach, including:
- Rehabilitative interventions, such as physical and occupational therapy, which are considered treatments of choice for functional motor symptoms 2
- Psychotherapy, which is an emerging evidence-based treatment across FND subtypes 2
- Inpatient treatment, which may be necessary for patients with acute or chronic symptoms, and can include physiotherapy and psychotherapy 3
Treatment Outcomes
Studies have shown that early diagnosis and treatment can promote recovery, although responses to treatment can be heterogeneous 2, 3. Some patients may experience partial or complete resolution of symptoms, while others may not improve or relapse 3.
Treatment Approaches
Different treatment approaches may be effective for different subtypes of FND, such as:
- Motor symptoms: rehabilitative interventions, such as physical and occupational therapy 2
- Seizure-type symptoms: psychotherapy, such as cognitive behavioral therapy-informed psychotherapy 4
- Comorbidities: medical-neurologic and psychiatric comorbidities should be assessed and integrated into treatment interventions and prognostic considerations 4