Inpatient Treatment of Functional Neurological Disorder: A Scoping Review

Abstract

Background: The aim of this scoping review is to describe the characteristics of patients requiring admission to hospital for functional neurological disorder (FND), assess interventions provided, and evaluate outcomes in the context of acute hospital presentation or elective admission with chronic symptoms (>3 months). Methods: A scoping review was performed. Included articles described adult patients admitted with FND to an inpatient care setting. Articles focusing on psychogenic non-epileptic attacks (PNEA) were excluded. Results: The search strategy identified 1963 citations. A total of 34 articles met inclusion criteria, with 458 patients (66% female) described. The pooled mean age of patients in all studies was 40.6 years. Eleven studies described patients with acute presentation, and 16 studies described patients with chronic FND symptoms admitted to the hospital. Motor symptoms were most common. Interventions were most commonly physiotherapy and psychotherapy. Most studies reported partial or complete resolution of symptoms. Conclusions: This scoping review summarizes the literature on the characteristics of patients admitted to the hospital, both with acute and chronic symptoms, for inpatient treatment of FND. When comparing patients with acute to those with chronic symptoms, we found that acute presentations were older (46.9 vs. 43.7 years) and had a higher representation of men (33% vs. 30%). Those presenting with chronic symptoms were more likely to not improve or relapse. We postulate that early diagnosis and inpatient rehabilitation could have a positive impact on outcomes for patients with FND.

Improvement in motor symptoms, physical fatigue, and self-rated change perception in functional motor disorders: a prospective cohort study of a 12-week telemedicine program

“…(3) improved quality of services by monitoring patients in their home rather than traveling to distant treatment centers can also improve the cost-effectiveness of interventions [53]. The recent scoping review by Gilmour and Jenkins [28] reported that while rehabilitation was consistently used as an inpatient intervention with positive results, most patients returned to independent function at discharge despite persistence of symptoms.…”

“…Adjuncts and innovations to improve access to specialist rehabilitation treatment by qualified professionals aided by advanced devices (i.e., tele/remote health and wearable technology) and long-term monitoring have seldom been explored in patients with FMDs [ 19 , 34 ]. By exploring a staged approach to FMDs, such as acute admission to specialized centers followed by outpatient programs ensuring appropriate treatment, the burden on the care system can be reduced [ 27 , 28 ]. Within this perspective, telemedicine offers many advantages: (1) regular communication between clinicians and real-time assessment of the patient’s environment; (2) patient improvement in satisfaction and quality of life, cutting the cost and labor of accessing health care; (3) improved quality of services by monitoring patients in their home rather than traveling to distant treatment centers can also improve the cost-effectiveness of interventions [ 53 ].…”

“…Multidisciplinary rehabilitation is essential to improve function and QoL in patients with FMDs [ 13 ]. Such patients may have much greater potential for recovery than health-care workers often think possible [ 13 , 28 ]. For example, based on the biopsychosocial model, intensive 5-day programs in FMDs have proved efficacious in improving motor and non-motor symptoms, with follow-up at 3 and/or 6 months [ 16 , 24 , 29 , 30 ].…”

Development of an inpatient rehabilitation pathway for motor functional neurological disorders: Initial reflections

“…The motor FND pathway was designed to have a fixed two-week endpoint. Other facilities have reported widely variable length of stays (LOS) for inpatient rehabilitation, ranging from a few days to several months (Demartini et al, 2014;Gilmour et. al, 2021;.…”

A Shift in Approach: Assessment and Treatment of Adults With Functional Neurological Disorder

“…There is a growing body of evidence highlighting the benefits of FND treatment. In a scoping review of inpatient treatment of 458 patients with FND, 90% showed at least some improvement in symptoms at discharge (Gilmour & Jenkins, 2021 ). Additionally, positive outcomes have been reported in shorter outpatient-only models of rehabilitation therapies (Czarnecki et al, 2012 ).…”