From the Guidelines
Conversion syndrome, now referred to as functional neurological symptom disorder, should be managed with a biopsychosocial approach, incorporating occupational therapy that focuses on education, rehabilitation within functional activity, and taught self-management strategies, as recommended by the 2020 consensus guidelines 1. The treatment of conversion syndrome, or functional neurological symptom disorder, is multifaceted, involving a combination of psychotherapy, physical rehabilitation, and sometimes medication to manage associated symptoms like anxiety or depression.
- Key aspects of treatment include:
- Psychotherapy, with cognitive behavioral therapy (CBT) being particularly effective
- Physical rehabilitation to address specific symptoms such as paralysis or seizures
- Medications like SSRIs (e.g., sertraline or escitalopram) for managing anxiety or depression
- A strong emphasis on patient education and reassurance that their symptoms are real and treatable According to the occupational therapy consensus recommendations for functional neurological disorder published in the Journal of Neurology, Neurosurgery and Psychiatry in 2020 1, occupational therapy plays a crucial role in the management of FND, emphasizing the importance of a biopsychosocial framework for assessment and intervention.
- The recommendations highlight the distinct aspects of occupational therapy for FND compared to other neurological conditions, underscoring the need for tailored approaches that include education, rehabilitation, and self-management strategies. Early diagnosis and intervention are critical for improving outcomes in patients with conversion syndrome, as they facilitate timely access to appropriate treatment and support, thereby enhancing the potential for recovery and improving quality of life, as suggested by the principles outlined in the 2020 guidelines 1.
From the Research
Definition and Characteristics of Conversion Syndrome
- Conversion syndrome, also known as functional neurological disorder (FND), is a condition characterized by neurological symptoms that lack an identifiable organic cause 2.
- These symptoms can consist of motor, sensory, or cognitive disturbances and are not deliberately produced, often varying in severity 2.
- The diagnosis of FND is predicated on clinical evaluation and the exclusion of other medical or psychiatric conditions 2.
Diagnosis and Treatment
- The treatment of FND typically involves a multidisciplinary approach, addressing each of the neurological symptoms and underlying psychological factors via a combination of medical management, psychotherapy, and supportive interventions 2.
- Recent advances in neuroimaging have shed new light on this disorder, highlighting the importance of a nuanced understanding of FND in informing clinical practice and guiding future research 2.
- Cognitive-behavioral therapy (CBT) has been shown to be effective in the rehabilitation of young patients with FNS, with significant improvements in clinical outcomes 3.
Triggers and Risk Factors
- Procedures involving anesthesia are relatively common triggers for the development of FNSD, with the hypothesis being that it arises from the abreactive or dissociative effects of anesthetic agents 4.
- Psychiatric co-morbidities such as anxiety and depression may be seen in patients with FNSD, and preoperative psychological assessment may help identify patients at risk 4.
- Microglial dysfunction could perpetuate functional changes within acute motor FND, providing a pathophysiological mechanism underlying the chronic stage of the motor FND phenotypes seen clinically 5.
Related Conditions and Treatments
- Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in the management of behavioral symptoms of frontotemporal lobar degeneration (FTLD), with marked improvements in disinhibition, irritability, aggression, and aberrant motor activity 6.
- However, the use of SSRIs in FND is not well established, and further research is needed to understand the potential benefits and risks of this treatment approach.