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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
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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

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