What is Functional Neurological Disorder (FND)?

From the Guidelines

Functional Neurological Disorder (FND) is a condition where patients experience neurological symptoms that cannot be explained by traditional neurological diseases or structural abnormalities, and it is diagnosed by a neurologist using 'positive clinical signs' and is not a diagnosis of exclusion. The diagnosis of FND is based on the presence of positive clinical signs, such as Hoover's sign, distractibility, entrainment of tremor, and variability in symptoms during function, as noted in the study by 1. FND can manifest with a wide range of symptoms, including weakness, movement disorders, sensory symptoms, cognitive deficits, and seizure-like events, as described in the study by 1. The treatment of FND typically involves a multidisciplinary approach, including physical therapy, psychotherapy, and patient education, with the goal of improving function and reducing symptoms, as recommended in the study by 1. Some key aspects of occupational therapy for FND include education, rehabilitation within functional activity, and the use of taught self-management strategies, as outlined in the study by 1. It is also important to address psychosocial predisposing and perpetuating factors, as noted in the study by 1, and to provide patient education and support to help individuals with FND understand their condition and develop coping strategies. Overall, the management of FND requires a comprehensive and individualized approach, taking into account the unique needs and circumstances of each patient, as emphasized in the study by 1.

Some of the key points to consider when managing FND include:

• The importance of early intervention and multidisciplinary treatment
• The need to address psychosocial factors and provide patient education and support
• The use of physical therapy and rehabilitation to improve function and reduce symptoms
• The potential benefits of psychotherapy, particularly cognitive behavioral therapy, in helping individuals with FND understand and manage their condition
• The importance of ongoing monitoring and adjustment of treatment as needed to ensure optimal outcomes.

In terms of specific treatment strategies, the study by 1 provides some examples of approaches that may be helpful, including:

• Education and explanatory approaches to help individuals understand their condition and develop coping strategies
• Symptomatic approaches, such as reduction of excessive musculoskeletal tension and elimination of secondary or accessory movements
• Psychological approaches, such as attention to psychosocial issues and cognitive features related to locus of control and executive function.

Overall, the management of FND requires a comprehensive and individualized approach, taking into account the unique needs and circumstances of each patient, and incorporating a range of treatment strategies and approaches to promote optimal outcomes.

From the Research

Definition and Overview of Functional Neurological Disorder (FND)

• Functional Neurological Disorder (FND) is a condition that sits at the intersection of neurology and psychology, with a variety of presentations, severity, and symptomatology 2.
• FND is a disabling condition with poor prognosis without treatment, but it can be managed with appropriate interventions 3.
• It is a heterogeneous condition, and severe forms can be disabling, affecting a considerable number of patients and influencing healthcare spending 2, 4.

Diagnosis and Treatment of FND

• FND is now considered a rule-in diagnosis, with available treatments, and early diagnosis can promote recovery 5.
• Validated rule-in examination signs can guide diagnosis, and therapeutic approaches are available to care for patients with FND 5.
• Rehabilitative interventions, such as physical and occupational therapy, are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence-based treatment across FND subtypes 5.

Management and Treatment Outcomes

• Multidisciplinary treatment and rehabilitation are recommended for severe FND, and clinical outcome data show significant improvements in quality of life, mobility, depression, and anxiety 3, 4.
• Patient confidence in treatment is a key predictor of clinical outcomes, and routine enquiry into depersonalisation derealisation experiences can help personalise FND treatment approaches 4.
• Setting up FND treatment services requires consideration of the types of services, referral identification, individualized treatment plans, and sustainable resource allocation 6.