Hostname: page-component-5b777bbd6c-cp4x8 Total loading time: 0 Render date: 2025-06-25T12:15:04.301Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of functional neurological disorder: current state, future directions, and a research agenda

Published online by Cambridge University Press:  07 December 2020

Kathrin LaFaver Open the ORCID record for Kathrin LaFaver [Opens in a new window] ,
William Curt LaFrance Jr. ,
Michele E. Price ,
Phyllis B. Rosen  and
Mark Rapaport Open the ORCID record for Mark Rapaport [Opens in a new window]
Kathrin LaFaver*
Affiliation:
Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
William Curt LaFrance Jr.
Affiliation:
Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
Michele E. Price
Affiliation:
Department of Neurology, Emory School of Medicine, Atlanta, Georgia, USA
Phyllis B. Rosen
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, Georgia, USA
Mark Rapaport
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, Georgia, USA
*
*Author for correspondence: Kathrin LaFaver, Email: kathrin.lafaver@northwestern.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Functional neurological disorder (FND) encompasses a complex and heterogeneous group of neuropsychiatric syndromes commonly encountered in clinical practice. Patients with FND may present with a myriad of neurological symptoms and frequently have comorbid medical, neurological, and psychiatric disorders. Over the past decade, important advances have been made in understanding the pathophysiology of FND within a biopsychosocial framework. Many challenges remain in addressing the stigma associated with this diagnosis, refining diagnostic criteria, and providing access to evidence-based treatments. This paper outlines FND treatment approaches, emphasizing the importance of respectful communication and comprehensive explanation of the diagnosis to patients, as critical first step to enhance engagement, adherence, self-agency, and treatment outcomes. We then focus on a brief review of evidence-based treatments for psychogenic non-epileptic seizures and functional movement disorder, a guide for designing future treatment trials for FND, and a proposal for a treatment research agenda, in order to aid in advancing the field to develop and implement treatments for patients with FND.

Keywords

Functional neurological disorderfunctional movement disorderconversion disorderpsychogenic non-epileptic seizurescognitive behavioral therapyrehabilitation
Type
Review
Information
CNS Spectrums , Volume 26 , Issue 6: Special Issue: Functional Neurological Disorder , December 2021 , pp. 607 - 613
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Espay, AJ, Aybek, S, Carson, A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol. 2018;75:1132–1141.CrossRefGoogle ScholarPubMed
Barnett, C, Davis, R, Mitchell, C, Tyson, S. The vicious cycle of functional neurological disorders: a synthesis of healthcare professionals' views on working with patients with functional neurological disorder. Disabil Rehabil. 2020 Sep 24;1–10 [Online ahead of print].CrossRefGoogle ScholarPubMed
Perez, DL, Aybek, S, Popkirov, S, et al. A review and expert opinion on the neuropsychiatric assessment of motor functional neurological disorders. J Neuropsychiatry Clin Neurosci. 2020. Aug 11:appineuropsych19120357. doi:10.1176/appi.neuropsych.19120357 [Online ahead of print].Google ScholarPubMed
Stone, J, LaFrance, WC Jr., Brown, R, Spiegel, D, Levenson, JL, Sharpe, M. Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res. 2011;71:369–376.CrossRefGoogle ScholarPubMed
Adams, C, Anderson, J, Madva, EN, LaFrance, WC Jr., Perez, DL. You've made the diagnosis of functional neurological disorder: now what? Pract Neurol. 2018;18:323–330.CrossRefGoogle Scholar
Tolchin, B, Baslet, G, Suzuki, J, et al. Randomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures. Epilepsia. 2019;60:986–995.CrossRefGoogle ScholarPubMed
Aybek, S, Lidstone, SC, Nielsen, G, et al. What is the role of a specialist assessment clinic for FND? Lessons from three national referral centers. J Neuropsychiatry Clin Neurosci. 2019. appineuropsych19040083. Winter 2020;32(1):79–84.CrossRefGoogle ScholarPubMed
Jacob, AE, Kaelin, DL, Roach, AR, Ziegler, CH, LaFaver, K. Motor retraining (MoRe) for functional movement disorders: outcomes from a 1-week multidisciplinary rehabilitation program. PM&R. 2018;10:1164–1172.Google ScholarPubMed
NHS Scotland (2012) Stepped care for functional neurological symptoms. Healthcare Improvement Scotland.Google Scholar
LaFrance, WC Jr., Devinsky, O. The treatment of nonepileptic seizures: historical perspectives and future directions. Epilepsia. 2004;45:15–21.CrossRefGoogle ScholarPubMed
LaFrance, WC Jr., Devinsky, O. Treatment of nonepileptic seizures. Epilepsy Behav. 2002;3:S19–S23.CrossRefGoogle ScholarPubMed
Goldstein, LH, Mellers, JD, Landau, S, et al. Cognitive behavioural therapy vs standardised medical care for adults with dissociative non-epileptic seizures (CODES): a multicentre randomised controlled trial protocol. BMC Neurol. 2015;15:98 CrossRefGoogle ScholarPubMed
Chen, DK, Maheshwari, A, Franks, R, Trolley, GC, Robinson, JS, Hrachovy, RA. Brief group psychoeducation for psychogenic nonepileptic seizures: a neurologist-initiated program in an epilepsy center. Epilepsia. 2014;55:156–166.CrossRefGoogle Scholar
Barrett-Naylor, R, Gresswell, DM, Dawson, DL. The effectiveness and acceptability of a guided self-help acceptance and commitment therapy (ACT) intervention for psychogenic nonepileptic seizures. Epilepsy Behav. 2018;88:332–340.CrossRefGoogle ScholarPubMed
Bullock, KD, Mirza, N, Forte, C, Trockel, M. Group dialectical-behavior therapy skills training for conversion disorder with seizures. J Neuropsychiatry Clin Neurosci. 2015;27:240–243.CrossRefGoogle ScholarPubMed
Howlett, S, Reuber, M. An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures. Psychotherapy: Theory Res Practice Training. 2009;46:125–138.CrossRefGoogle ScholarPubMed
Myers, L, Vaidya-Mathur, U, Lancman, M. Prolonged exposure therapy for the treatment of patients diagnosed with psychogenic non-epileptic seizures (PNES) and post-traumatic stress disorder (PTSD). Epilepsy Behav. 2017;66:86–92.CrossRefGoogle Scholar
LaFrance, WC Jr, Bjønaes, H. Chapter 28. Designing treatment plans based on etiology of psychogenic noenpileptic seizures. In: LaFrance, WC Jr, Schachter, SC, eds. Gates and Rowan's Nonepileptic Seizures. 4th ed. New York: Cambridge University Press; 2018:283–299.CrossRefGoogle Scholar
Beck, AT. Cognitive Therapy and the Emotional Disorders. New York, NY: International Universities Press; 1976.Google Scholar
Beck, JS. Cognitive Therapy: Basics and Beyond. New York, NY: Guilford Press; 1995.Google Scholar
Reiter, JM, Andrews, D, Reiter, C, LaFrance, WC. Jr Taking Control of Your Seizures: Workbook. New York, NY: Oxford University Press; 2015.CrossRefGoogle Scholar
LaFrance, WC Jr, Wincze, JP. Treating Nonepileptic Seizures: Therapist Guide. New York, NY: Oxford University Press; 2015.CrossRefGoogle Scholar
LaFrance, WC Jr., Miller, IW, Ryan, CE, et al. Cognitive behavioral therapy for psychogenic nonepileptic seizures. Epilepsy Behav. 2009;14:591–596.CrossRefGoogle ScholarPubMed
LaFrance, WC Jr., Baird, GL, Barry, JJ, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014;71:997–1005.CrossRefGoogle ScholarPubMed
Reiter, J, Andrews, D, Janis, C. Taking Control of Your Epilepsy. A Workbook for Patients and Professionals. 1st ed. Santa Rosa, CA: The Basics; 1987.Google Scholar
LaFrance, WC Jr., Ho, WLN, Bhatla, A, Baird, GL, Altalib, HH, Godleski, L. Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth. Epilepsia. 2020. early view. doi:10.1111/epi.16689.CrossRefGoogle ScholarPubMed
Jung, Y, Chen, DK, Bullock, KD, et al.. Chapter 33. Training in treatment of psychogenic nonepileptic seizures. In: LaFrance, WC Jr, Schachter, SC, eds. Gates and Rowan's Nonepileptic Seizures. 4th ed. New York, NY: Cambridge University Press; 2018:344–357.CrossRefGoogle Scholar
LaFrance, WC Jr., Ho, WLN, Bhatla, A, Baird, G, Altalib, HH, Godleski, L. Examination of potential differences in reporting of sensitive psychosocial measures via diagnostic evaluation using computer video telehealth. J Neuropsychiatry Clin Neurosci. 2020;32:294–301.CrossRefGoogle ScholarPubMed
McMillan, KK, Pugh, MJ, Hamid, H, et al. Providers' perspectives on treating psychogenic nonepileptic seizures: frustration and hope. Epilepsy Behav. 2014;37:276–281.CrossRefGoogle ScholarPubMed
Sharpe, M, Walker, J, Williams, C, et al. Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology. 2011;77:564–572.CrossRefGoogle ScholarPubMed
Moene, FC, Spinhoven, P, Hoogduin, KA, van Dyck, R. A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn. 2003;51:29–50.CrossRefGoogle ScholarPubMed
Nielsen, G, Ricciardi, L, Demartini, B, Hunter, R, Joyce, E, Edwards, MJ. Outcomes of a 5-day physiotherapy programme for functional (psychogenic) motor disorders. J Neurol. 2015;262:674–681.CrossRefGoogle ScholarPubMed
Nielsen, G, Stone, J, Matthews, A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurology Neurosurg Psychiatry. 2015;86:1113–1119.CrossRefGoogle ScholarPubMed
Jordbru, AA, Smedstad, LM, Klungsoyr, O, Martinsen, EW. Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up. J Rehabil Med. 2014;46:181–187.CrossRefGoogle ScholarPubMed
Saifee, TA, Kassavetis, P, Parees, I, et al. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol. 2012;259:1958–1963.CrossRefGoogle ScholarPubMed
Jacob, AE, Smith, CA, Jablonski, ME, et al. Multidisciplinary clinic for functional movement disorders (FMD): 1-year experience from a single centre. J Neurology Neurosurg Psychiatry. 2018;89:1011–1012.CrossRefGoogle ScholarPubMed
McCormack, R, Moriarty, J, Mellers, JD, et al. Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study. J Neurol Neurosurg Psychiatry. 2014;85:895–900.CrossRefGoogle ScholarPubMed
Taib, S, Ory-Magne, F, Brefel-Courbon, C, et al. Repetitive transcranial magnetic stimulation for functional tremor: A randomized, double-blind, controlled study. Mov Disord. 2019;34:1210–1219.CrossRefGoogle ScholarPubMed
Pick, S, Hodsoll, J, Stanton, B, et al. Trial of neurostimulation in conversion symptoms (TONICS): a feasibility randomised controlled trial of transcranial magnetic stimulation for functional limb weakness. BMJ Open. 2020;10:e037198Google ScholarPubMed
LaFrance, WC Jr, Blumer, DP. Chapter 32. Pharmacological treatments for psychogenic nonepileptic seizures. In: LaFrance, WC Jr, Schachter, SC, eds. Gates and Rowan's Nonepileptic Seizures. 4th ed. New York, NY: Cambridge University Press; 2018:334–343.CrossRefGoogle Scholar
Butler, M, Seynaeve, M, Nicholson, TR, et al. Psychedelic treatment of functional neurological disorder: a systematic review. Ther Adv Psychopharmacol. 2020;10. doi:10.1177/2045125320912125.CrossRefGoogle ScholarPubMed
Kaas, BM, Humbyrd, CJ, Pantelyat, A. Functional movement disorders and placebo: a brief review of the placebo effect in movement disorders and ethical considerations for placebo therapy. Mov Disord Clin Pract. 2018;5:471–478.CrossRefGoogle ScholarPubMed
Bullock, KD. Chapter 31. Group treatments for psychogenic nonepileptic seizures. In: LaFrance, WC Jr, Schachter, SC, eds. Gates and Rowan's Nonepileptic Seizures. 4th ed. New York, NY: Cambridge University Press; 2018:325–333.CrossRefGoogle Scholar
Pick, S, Anderson, DG, Asadi-Pooya, AA, et al. Outcome measurement in functional neurological disorder: a systematic review and recommendations. J Neurol Neurosurg Psychiatry. 2020;91:638–649.CrossRefGoogle ScholarPubMed
Goldstein, LH, Robinson, EJ, Mellers, JDC, et al. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry. 2020;7:491–505.CrossRefGoogle ScholarPubMed
Gronseth, GS, Cox, J, Gloss, D, et al. Clinical Practice Guideline Process Manual. Minneapolis, MN: American Academy of Neurology; 2017.Google Scholar