Treatment of Functional Neurological Disorder
The cornerstone of effective treatment for Functional Neurological Disorder (FND) is a biopsychosocial approach with multidisciplinary rehabilitation focused on education, functional activity, and self-management strategies. 1
Core Treatment Components
Multidisciplinary Rehabilitation
- Multidisciplinary approaches show promising outcomes with improvements in physical function and quality of life, with benefits maintained at follow-up periods of 12-25 months 1
- Key team members include:
- Neurologists (for diagnosis and treatment planning)
- Occupational therapists
- Physical therapists
- Speech and language therapists (for relevant symptoms)
- Psychologists/psychiatrists
Treatment Phases
1. Initial Phase
- Education about FND:
- Explain that FND is a real, common, and disabling neurological condition
- Symptoms result from a potentially reversible miscommunication between brain and body
- Symptoms are outside the person's conscious control 1
- Establish therapeutic rapport and agree on treatment parameters
2. Active Rehabilitation Phase
Functional retraining:
- Retraining normal movement patterns within functional activities
- Graded reintroduction to daily activities
- Establishment of structure and routine 1
Symptom-specific interventions:
For functional tremor/movement disorders:
- Encourage "slow" movement activities (yoga, tai chi)
- Redirect attention away from symptoms 2
For functional dystonia:
- Promote optimal postural alignment
- Encourage even weight distribution
- Grade activities to increase affected limb use
- Avoid prolonged positioning of joints at end ranges 2
For functional limb weakness:
- Engage in tasks promoting normal movement and alignment
- Focus on bilateral tasks that require use of affected limbs 2
For functional cognitive impairment:
- Address contributing factors (pain, fatigue, anxiety, poor sleep)
- Implement practical cognitive strategies 2
Psychological interventions:
- Address unhelpful thoughts, beliefs, and behaviors
- Implement anxiety management techniques
- Use sensory grounding techniques to prevent dissociation 1
3. Maintenance Phase
- Develop relapse prevention planning
- Establish ongoing self-management strategies
- Gradually reduce clinical support 1
Important Considerations
Avoid Counterproductive Approaches
- Avoid splinting or immobilizing devices that can lead to muscle deconditioning 2, 1
- Potential problems with splinting include:
- Increased attention/focus on the affected area
- Increased accessory muscle use
- Development of compensatory movement strategies
- Muscle deconditioning from immobilization
- Learnt non-use
- Increased pain 2
Self-Management Strategies
- Diaphragmatic breathing and progressive muscle relaxation
- Sensory grounding techniques (noticing environmental details, feeling textured items)
- Anxiety management and distraction techniques during tasks 2
Family and Work Support
- Provide family education to reinforce therapeutic approaches
- Support work/study modifications and develop graded return plans 1
Treatment Outcomes
- Multidisciplinary rehabilitation approaches can lead to meaningful improvements in function and quality of life
- Benefits include improvements in physical symptoms, mental health, well-being, function, and reduced healthcare resource use 1
Common Pitfalls to Avoid
- Focusing solely on symptom reduction rather than functional improvement
- Inconsistent communication between healthcare providers
- Overreliance on compensatory aids that may interrupt normal movement patterns
- Neglecting psychological factors contributing to symptom maintenance
- Failing to address contributing factors such as fatigue, pain, anxiety, and poor sleep
By implementing this comprehensive treatment approach, patients with FND can experience significant improvements in function and quality of life, with benefits that can be maintained long-term.