What is the treatment approach for Functional Neurological Disorder (FND) syndrome?

Treatment Approach for Functional Neurological Disorder (FND) Syndrome

The treatment of Functional Neurological Disorder requires a biopsychosocial approach with multidisciplinary rehabilitation focused on education, functional activity, and self-management strategies as the cornerstone of effective management. 1

Core Treatment Components

Education and Diagnosis Communication

• Education is a critical first step in FND treatment 1
• Explain that FND is:
  • A real, common, and disabling neurological condition
  • Symptoms are outside the person's conscious control
  • Results from potentially reversible miscommunication between brain and body
  • Not "all in the head" or imagined

Rehabilitation Framework

• Implement a three-phase treatment approach:

1. Initial Phase

• Deliver comprehensive education about FND
• Establish therapeutic rapport
• Agree on treatment parameters
• Introduce self-management concepts 1

2. Active Rehabilitation Phase

• Implement interventions focused on function rather than impairment
• Engage patients in tasks promoting normal movement patterns and even weight distribution
• Focus on gross rather than fine movements for retraining function
• Use variability of symptoms positively in treatment 1

3. Maintenance Phase

• Complete relapse prevention planning
• Develop ongoing self-management strategies
• Gradually reduce clinical support 1

Specific Therapeutic Interventions

Occupational Therapy

• Retraining normal movement within functional activities
• Graded reintroduction to daily activities
• Establishment of structure and routine
• Address unhelpful thoughts, beliefs, and behaviors 2
• Avoid splints or immobilizing devices that can lead to muscle deconditioning 1
• Prevent overreliance on compensatory aids that may interrupt normal automatic movement patterns 1

Physical Therapy

• Implement strategies to reduce muscle overactivity, pain, and fatigue
• Focus on even weight distribution and normal movement patterns 1

Speech and Language Therapy (when applicable)

• Help patients regain voluntary control over speech and swallowing
• Extend automatic activities into graded, functionally relevant tasks 1

Psychological Interventions

• Address psychological factors contributing to symptom maintenance
• Consider cognitive behavioral therapy (CBT) and psychodynamic therapy (PDT)
• Encourage patients to notice and challenge unhelpful thoughts
• Address catastrophizing and fear avoidance behaviors 1

Management of Contributing Factors

• Implement strategies for:
  • Fatigue management
  • Pain control
  • Anxiety reduction
  • Sleep improvement
• Incorporate relaxation and sensory grounding techniques
• Establish daily routines to prevent activity and cognitive overload 1

Important Treatment Principles

Do's:

• Prioritize functional improvement and quality of life over symptom reduction
• Maintain open and consistent communication between healthcare professionals
• Support work/study modifications and graded return plans
• Include family education to reinforce therapeutic approaches 1

Don'ts:

• Avoid using splints or immobilizing devices
• Prevent overreliance on compensatory aids
• Avoid inconsistent communication between healthcare professionals 1

Treatment Efficacy

• Multidisciplinary approaches show promising outcomes with improvements in physical function and quality of life
• Benefits can be maintained at follow-up periods of 12-25 months 2
• Psychological therapies like CBT and PDT provide medium-sized benefits for physical symptoms, mental health, well-being, function, and resource use 1

Common Pitfalls to Avoid

• Treating FND like other neurological conditions with standard neurorehabilitation approaches
• Focusing on impairment rather than function
• Using immobilizing devices that can lead to muscle deconditioning
• Inconsistent communication between healthcare professionals
• Failing to address psychological factors contributing to symptom maintenance

By implementing this comprehensive treatment approach, healthcare providers can help patients with FND achieve meaningful improvements in function and quality of life.