From the Guidelines
The first line of treatment for Functional Neurological Disorder (FND) should be a multidisciplinary approach that includes occupational therapy, emphasizing education, rehabilitation within functional activity, and the use of taught self-management strategies, as recommended by the most recent consensus guidelines 1. This approach prioritizes a biopsychosocial aetiological framework, recognizing FND as a real and disabling condition that requires empathetic understanding and a therapeutic alliance between the patient and healthcare team.
Key Components of Treatment
- Education about the diagnosis and symptoms, involving significant others when possible, to ensure a comprehensive understanding of FND 1.
- Rehabilitation focused on functional activities, aiming to retrain normal movement patterns and gradually rebuild function, rather than solely on impairment-based goals 1.
- The use of taught self-management strategies to empower patients in managing their condition effectively, including recognizing and challenging unhelpful thoughts, beliefs, and behaviors 1.
- Integration of specific treatment techniques into daily functions, showing patients how to carry these over independently, and focusing on activity-based goals 1.
- Avoidance of compensatory aids and techniques in the acute phase or during active rehabilitation, as well as avoiding the use of splints or devices that immobilize joints, to promote active recovery and prevent dependency 1.
Additional Considerations
- Cognitive behavioral therapy (CBT) may complement physical rehabilitation by addressing unhelpful thought patterns and behaviors that may perpetuate symptoms.
- Medication is not typically the primary treatment for FND but may be used to address comorbid conditions like depression or anxiety if present.
- Early intervention with this multidisciplinary approach is crucial, as outcomes tend to be better when treatment begins soon after symptom onset, requiring consistent patient engagement and a therapeutic alliance between the patient and healthcare team.
From the Research
Treatment Options for Functional Neurological Disorder (FND)
The first line of treatment for Functional Neurological Disorder (FND) typically involves a combination of rehabilitative and psychological interventions.
- Rehabilitative interventions, such as physical and occupational therapy, are considered the treatments of choice for functional motor symptoms 2.
- Psychotherapy is also an emerging evidence-based treatment across FND subtypes, including motor and seizure-type symptoms 2.
- The goal of these interventions is to promote recovery and improve symptoms, although responses to treatment can be heterogeneous, and more research is needed to individualize treatments and develop novel interventions 2.
Importance of Early Diagnosis and Treatment
Early diagnosis and access to evidence-based treatments are crucial for promoting recovery in patients with FND.
- A timely diagnosis can help reduce the risk of severe disability and improve patient outcomes 3, 4.
- Inpatient treatment may be necessary for some patients, particularly those with acute or chronic symptoms, and can involve a range of interventions, including physiotherapy and psychotherapy 4.
Role of the Neurologist in FND Treatment
The neurologist plays a critical role in the treatment of FND, extending beyond diagnosis to include elements of treatment during the assessment process.
- The neurologist can provide reassurance, explanation, and advice on self-help techniques, as well as refer patients to appropriate physiotherapy and psychological services 5.
- A positive and supportive approach can help patients feel more empowered and motivated to engage in treatment, which is essential for improving symptoms and promoting recovery 5.