Objective: To explore modifications to an established, evidence-based psychological treatment for patients with psychogenic non-epileptic seizures (PNES) with the goal of studying a manualized psychotherapy tailored for treating patients with functional movement disorder (FMD)

Background: Mounting evidence exists for the use of psychological interventions to treat patients with functional neurological disorders (FNDs), including both PNES and FMD. Neuro-Behavioral Therapy (NBT; 1) is an evidence-based, 12-session, manualized, multi-modality psychotherapy developed for the treatment of seizures including PNES (2) that has also been used to treat FMD (3), however, no movement disorder-specific equivalent of the patient workbook is currently publicly available.  While PNES and FMD represent variants of the same disorder (FNDs), modifying workbook language and concepts to reflect movement disorder specific patient-experience may optimize relevance and understanding of material, treatment “buy in,” and ultimately outcomes in NBT treatment of FMD. A manualized workbook approach for FMD psychotherapy could improve communication and treatment reliability among therapists and foster dissemination of a psychotherapy intervention to improve access for FMD patients.

Method: Case discussion and qualitative analysis.

Results: A modified, movement disorder-specific version of the NBT-patient workbook was developed based on the experience of the authors in treating FMD (and PNES), input from FMD patients, and qualitative discussion with other NBT therapists. Some modifications for the FMD version include:  Including FMD clinical vignettes and changing seizure language to movement disorders, education on movement disorder phenomenology, modification of symptom tracking log to reflect movement disorder patient experience, and replacing content on “Identifying pre-seizure aura” with a chapter on encouraging normal movement and motor retraining. Cases with FMD using the workbook reported improvements in abnormal movements, psychological wellbeing, and global functioning.

Conclusion: NBT is an established, manualized, multi-modality psychotherapy used with patients with seizures, which has been modified to treat movement disorders. Further study is needed to validate the efficacy of NBT for FMD.

References: 1- Reiter J, Andrews D, Reiter C, LaFrance WC Jr, Oxford University Press. Taking control of your seizures. Workbook. New York: Oxford University Press; 2015. 2- LaFrance WC Jr, Baird GL, Barry JJ, Blum AS, Frank Webb A, Keitner GI, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry 2014 September 01;71(9):997-1005. 3- LaFrance WC Jr, Friedman JH. Cognitive behavioral therapy for psychogenic movement disorder. Mov Disord 2009 September 15;24(12):1856-1857.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuro-behavioral-therapy-for-functional-movement-disorders-conceptual-framework-and-future-directions/