Management of functional neurological disorder

Abstract

Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. These symptoms are varied and include abnormal control of movement, episodes of altered awareness resembling epileptic seizures and abnormal sensation and are often comorbid with chronic pain, fatigue and cognitive symptoms. There is increasing evidence for the role of neurologists in both the assessment and management of FND. The aim of this review is to discuss strategies for the management of FND by focusing on the diagnostic discussion and general principles, as well as specific treatment strategies for various FND symptoms, highlighting the role of the neurologist and proposing a structure for an interdisciplinary FND service.

Difficulties in Management of Functional Movement Disorders: Three Illustrative Cases

“…Treatment for FND varies considerably, depending on symptom presentation and the center providing treatment. 5 , 6 The standard treatment is MDT rehabilitation with an emphasis on cognitive behavioral therapy. 7 Clinicians often de‐medicalize treatment where possible, encouraging patients to focus on more “normal” or “natural” movements and discourage using aids or adaptations as these can act as maintaining factors for abnormal posture and movement patterns.…”

#3100 A service evaluation of the experiences of patients with functional neurological disorders within the NHS

“…Thus, the development of specialist multi-disciplinary FND clinics has the promise of improving both access to care and patient experiences. Gilmour et al (14) noted that improving the knowledge and skills of community-based healthcare professionals and primary care workers is a vital step in developing effective, interdisciplinary stepped-care pathways for FND, which further highlights the role of education in improving care for FND patients. NHS England (55) has emphasised the importance of involving patients in the development of care pathways, suggesting there is also a need for both more research into FND patients' experiences of healthcare and the use of patient steering groups in order to deliver genuine patientcentred care.…”

“…Jackson et al (51) found that people with LTNCs viewed coordination between services as vital in ensuring that there is a continuity of care within community settings, but that they often experienced limited access to these services. Since FND is often managed within community settings and requires multidisciplinary treatment (14), it is thus vital to have coordination between different services which should include, for many patients, a coordination between community neurotherapy and community mental health services.…”

“…People with FND often have to be seen multiple times before a definite diagnosis is made, causing marked delays in diagnosis delivery and uncertainty around the diagnosis (12,13). The management of FND requires specialist multidisciplinary care across many services, including both health and social care services within community and hospital settings, and spanning both physical and mental health providers (14,15). This can be challenging due to differing approaches to management from different healthcare professionals and between services, the lack of resources available for FND care, and there being a lack of knowledge about FND within healthcare services (16,17).…”

“…However, whilst the need to improve the care pathway and patient experience for FND has been previously identified (14,22,23), there has been limited research into how FND patients experience the care they receive. Whilst there has recently been key developments in identifying the need for more patientreported outcome measurements (PROMs) for people with FND and in increasing the validity of these measurements (24,25), there has been little development in patient-reported experience measures (PREMs).…”