This is the article the letter above is responding to:
Rixon M, Clarke K, Hernandez S, et al. Characteristics and Multidisciplinary team management of FND. Progress in Neurology and Psychiatry 2023
Abstract
Care of patients with functional neurological disorders (FND) is complex, often with poor outcomes. There is currently only low quality evidence of interventions needed for recovery in the acute phase. In this paper the characteristics of a cohort of acute FND patients managed within a large tertiary neurosciences centre are described and health service provision explored to identify fidelity with best practice.
Functional neurological disorders (FND), also known as conversion disorders, are a common presentation to major neurology and stroke care units in tertiary hospitals. The incidence ranges from 4 to 12 per 100 000, comparable with multiple sclerosis, and is the second most common diagnosis in outpatient neurology clinics.
1 The majority of patients continue to experience symptoms and disability years after initial onset of the condition.
2
FND is defined by motor or sensory neurological symptoms, including weakness, numbness and seizures, without an identifiable organic cause.
3 Recently, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) made changes to the diagnostic criteria for FND to include use of positive clinical findings on objective examination and removal of identifying underlying stressors as an attributable cause.
4,
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FND may begin suddenly, progress quickly, increase with attention or excessive fatigue and disappear with distraction.
6 Symptom presentation is often complex and successful intervention entails a holistic interdisciplinary treatment plan from medical, psychiatric and allied health professionals (AHPs).
7 The prognosis for FND is often unfavourable with poor outcomes being linked to late diagnosis and prolonged symptom duration.
2
The interdisciplinary team plays an important role in providing education around illness beliefs and demonstrating that normal movement is possible and maladaptive behaviours can be changed.
7 Over the last decade research findings have supported physiotherapy as a positive intervention for FND patients with motor deficits.
7,
8 A consensus recommendation for physiotherapy advocates a biopsychosocial model of care using an individualised treatment plan and a stepped approach.
9 A systematic review of outcomes for FND patients reported that 60–70% improved post physiotherapy intervention.
9
The number of specialised FND clinics across the health care system in Australia is limited.
10 Although FND management, involving an early interdisciplinary approach with appropriate outpatient follow-up, has been recommended, there is currently only low-quality evidence regarding therapeutic intervention in the acute phase of FND.
11
The aim of this paper was to describe a cohort of acute FND patients managed within a large tertiary neurosciences centre. We sought to define current practice and investigate barriers limiting translation of best practice guidelines.
