From the Guidelines
The guideline approach to treating functional neurological disorder (FND) involves a multidisciplinary strategy centered on clear diagnosis communication, psychotherapy, and rehabilitation, as recommended by recent studies 1.
Key Components of Treatment
- Treatment begins with a thorough explanation to the patient that their symptoms are real but represent a disorder in brain functioning rather than structural damage.
- Cognitive behavioral therapy (CBT) is the first-line psychological treatment, typically delivered in 12-16 weekly sessions, focusing on identifying triggers and modifying maladaptive thought patterns.
- Physical, occupational, and speech therapy are crucial components, with specialized rehabilitation programs targeting specific functional symptoms like movement disorders or seizures.
- Medications are generally not primary treatments but may be used adjunctively - antidepressants like sertraline (50-200mg daily) or duloxetine (30-60mg daily) can help manage comorbid anxiety or depression, while low-dose antipsychotics might occasionally be used for severe motor symptoms.
Importance of Multidisciplinary Approach
- Patient education materials and support groups enhance treatment engagement.
- Regular follow-up appointments, typically every 1-3 months initially, help monitor progress and adjust treatment plans.
- This integrated approach addresses both the neurological and psychological aspects of FND, recognizing that symptoms arise from disrupted brain networks rather than conscious fabrication, and treatment success depends on addressing underlying psychological factors while simultaneously retraining normal movement patterns and neurological function.
Considerations for Outcome Measurement
- Outcome measures should capture key domains such as core physiological/clinical symptoms, life impact, resource use, adverse events, and mortality, as suggested by the Core Outcome Measures in Effectiveness Trials (COMET) initiative and the development of ‘common data elements’ supported by the National Institutes of Health 1.
- Future research should prioritize the development and validation of FND-specific outcome measures, explore additional avenues for outcome measurement, and examine the perspectives of patients, carers, and other relevant stakeholders on outcome measurement in FND.
From the Research
Guideline Approach to Functional Neurological Disorder (FND)
The guideline approach to treating Functional Neurological Disorder (FND) involves a comprehensive and multidisciplinary strategy. Key aspects of this approach include:
- Early diagnosis using validated rule-in examination signs to guide diagnosis 2
- Access to evidence-based rehabilitative and/or psychological treatments to promote recovery 2, 3
- Individualized treatment plans, as responses to treatment can be heterogeneous 2, 4
Treatment Options
Treatment options for FND include:
- Rehabilitative interventions (physical and occupational therapy) for functional motor symptoms 2
- Psychotherapy, an emerging evidence-based treatment across FND subtypes 2, 5
- Cognitive behavioral therapy (CBT), which can be delivered remotely to alleviate access obstacles 5
- Inpatient treatment for severely or chronically impaired patients, integrating various modalities 6
Diagnostic Considerations
Diagnostic considerations for FND involve:
- Making a diagnosis in an inclusionary manner by identifying neurological signs specific to FNDs 4
- Considering a wider range of past sensitizing events, such as physical trauma or medical illness 4
- Recognizing neurobiological abnormalities, including hypoactivation of the supplementary motor area 4
Future Directions
Future directions for FND treatment and research include: