From the Guidelines
The first line of treatment for patients with Functional Neurological Disorders (FND) should be a multidisciplinary approach that prioritizes education, explanation, and a biopsychosocial framework, as recommended by the most recent consensus guidelines 1. This approach begins with a clear, empathetic explanation to the patient that their symptoms are real but represent a problem with how the nervous system functions rather than structural damage.
Key Components of Treatment
- Education about the diagnosis and symptoms
- Rehabilitation within functional activity
- Use of taught self-management strategies
- Psychological interventions, such as cognitive behavioral therapy (CBT), to address underlying psychological factors, stress management, and coping strategies
- Occupational therapy to help patients regain independence in daily activities
- Speech therapy for those with functional speech disorders
Considerations for Treatment
- Factors important for engagement with treatment include a reasonable degree of understanding and agreement with the diagnosis, and motivation and agreement to treatment 1
- Circumstances that may suggest a guarded or poor prognosis include transient or highly variable symptoms, unresolved litigation related to symptoms, severe psychiatric comorbidity, and other severe FND symptoms 1
Medication Use
Medication is not typically the primary treatment for FND, but may be used to address comorbid conditions like depression or anxiety, with SSRIs such as sertraline or escitalopram often prescribed 1
Importance of Early Intervention
Early intervention is crucial, even in the presence of severe FND symptoms, to improve outcomes and reduce morbidity, mortality, and impact on quality of life 1
From the Research
Treatment Approaches for Functional Neurological Disorders (FND)
The first line of treatment for patients with Functional Neurological Disorders (FND) typically involves a multidisciplinary approach, including rehabilitative therapies and psychological therapies.
- Rehabilitative interventions, such as physical therapy and occupational therapy, are often used to treat functional motor symptoms 2.
- Psychotherapy is also an emerging evidence-based treatment across FND subtypes, including those with seizure-type symptoms 2.
- The optimal timing of specific therapeutic interventions is crucial and should be patient-centered, emphasizing the importance of individualized treatment plans 3.
Role of Occupational Therapy in FND Management
Occupational therapy (OT) plays a significant role in the management of FND, particularly in addressing sensory processing difficulties and improving functional neurological symptoms.
- OT can help patients with FND develop strategies to manage sensory modulation difficulties, which are common in this population 4.
- The use of standardized assessments, such as the Adolescent/Adult Sensory Profile (AASP) and The Canadian Occupational Performance Measure (COPM), can aid in the development of individualized treatment plans 4.
Importance of Early Diagnosis and Treatment
Early diagnosis and access to evidence-based treatments are critical in promoting recovery for patients with FND.