Diagnosis and management of functional neurological disorderBMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o64 (Published 24 January 2022) Cite this as: BMJ 2022;376:o64
- 1Neurology Department, Psychosomatic Medicine Unit, Inselspital University Hospital, Bern, and Bern University, Bern, Switzerland
- 2Divisions of Cognitive Behavioral Neurology and Neuropsychiatry, Functional Neurological Disorder Unit, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Correspondence to S Aybek
Functional neurological disorder (FND), previously regarded as a diagnosis of exclusion, is now a rule-in diagnosis with available treatments. This represents a major step toward destigmatizing the disorder, which was often doubted and deemed untreatable. FND is prevalent, generally affecting young and middle aged adults, and can cause severe disability in some individuals. An early diagnosis, with subsequent access to evidence based rehabilitative and/or psychological treatments, can promote recovery—albeit not all patients respond to currently available treatments. This review presents the latest advances in the use of validated rule-in examination signs to guide diagnosis, and the range of therapeutic approaches available to care for patients with FND. The article focuses on the two most frequently identified subtypes of FND: motor (weakness and/or movement disorders) and seizure type symptoms. Twenty two studies on motor and 27 studies on seizure type symptoms report high specificities of clinical signs (64-100%), and individual signs are reviewed. Rehabilitative interventions (physical and occupational therapy) are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence based treatment across FND subtypes. The literature to date highlights heterogeneity in responses to treatment, underscoring that more research is needed to individualize treatments and develop novel interventions.
Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors
Contributors: SA drafted the outline of the draft, designed collection of data, collected and analyzed data, critically appraised data, and wrote and edited the final manuscript. She is guarantor.
DLP drafted the outline of the draft, designed collection of data, collected and analyzed data, critically appraised data, and wrote and edited the final manuscript. He is guarantor.
Both SA and DLP selected the relevant articles, reviewed critically the literature, and wrote the manuscript.
The CEO and Founder of a charity contributed to efitting the final manuscript.
Funding: SA was supported by the Swiss National Science Foundation grant PP00P3_176985.
DLP was supported by the Sidney R Baer Jr Foundation.
Competing interests: SA has received honorariums for continuing medical education lectures in functional neurological disorder, is a member of the research committee of the American Neuropsychiatric Association, and is on the editorial board of Cognitive Neuropsychiatry.
DLP has received honorariums for continuing medical education lectures in functional neurological disorder, is a member of the research committee of the American Neuropsychiatric Association, and is on the editorial board of Epilepsy and Behavior.
Provenance and peer review: Commissioned; externally peer reviewed.