What is the recommended treatment approach for patients with Functional Neurological Disorder (FND)?

Treatment Approach for Functional Neurological Disorder (FND)

The recommended treatment approach for Functional Neurological Disorder (FND) is a multidisciplinary intervention combining physical therapy, psychological therapy, and neurological management, which has shown substantial improvements in quality of life and functional outcomes. 1

Core Treatment Components

Diagnostic Communication

• Clear communication of the diagnosis is essential and forms the foundation of treatment 2, 3
• Validate symptoms while providing a clear explanation of the functional nature of the disorder 3
• Use consistent and respectful language when discussing the diagnosis 3

Multidisciplinary Team Approach

• The most effective treatment model involves simultaneous care from:
  • Neurologist
  • Physiotherapist/Physical therapist
  • Clinical psychologist
  • Psychiatrist (when needed) 1

Specific Therapeutic Interventions

1. Physical Rehabilitation Therapy

   • Tailored physical therapy focusing on normal movement patterns
   • Occupational therapy for functional impairments
   • Speech and language therapy for functional speech disorders 2

2. Psychological Interventions

   • Cognitive Behavioral Therapy (CBT) shows medium-sized benefits for:
     • Physical symptoms
     • Mental health
     • Well-being
     • Functional improvement 4
   • Psychodynamic Therapy (PDT) also demonstrates comparable benefits, though with fewer high-quality studies 4

3. Environmental Management

   • Create a calm environment to reduce stress and symptom exacerbation 3
   • Avoid iatrogenic harm from unnecessary testing or interventions 3

Treatment Setting Considerations

The most recent evidence supports integrated multidisciplinary clinics where patients are seen simultaneously by multiple specialists. This approach has demonstrated:

• Significant improvements in 7 out of 8 quality of life domains
• Reduction in work and social adjustment difficulties by approximately 50%
• Improved employment status with no patients experiencing worsening occupational status 1

Implementation Challenges and Solutions

• Resource Limitations: Balance patient needs with healthcare resources by developing sustainable FND-specific services 5
• Referral Pathways: Establish clear criteria for appropriate referrals to FND services 5
• Treatment Planning: Develop and monitor individualized treatment plans based on symptom presentation 5
• Continuity of Care: Ensure appropriate follow-up after initial treatment 3

Special Considerations for Acute Presentations

For emergency department management:

• Maintain a low threshold for investigating potential comorbid neurological conditions
• Avoid repetitive testing that may reinforce illness behavior
• Involve physiotherapy and psychological support early 3

Treatment Efficacy

The most recent evidence (2023) demonstrates that integrated multidisciplinary clinics produce:

• Quality of life improvements of 23-39 points across multiple domains
• Work and Social Adjustment Scale scores improving from 26 to 13 (lower is better)
• Improved employment status in multiple patients 1

This approach appears more accessible for non-specialist centers compared to other interventions for FND 1.