Objective: To develop evidence-based, expert consensus recommendations for the treatment of functional neurological disorders (FND) on behalf of the ANPA Committee for Research.

Background: FND are common in neurology services and can be difficult to treat. There is a pressing need for evidence-based recommendations to guide clinicians, to inform clinical research, and to develop effective and efficient health care services for this population.

Methods: A systematic search of PubMed was conducted using the terms “functional neurological disorder” and “conversion disorder” combined with «treatment» or «management» and «clinical trial». Abstracts were screened by two investigators and relevant articles reviewed for sample size, symptom(s), intervention, endpoints, and key findings. This search was supplemented with relevant references from treatment chapters recently published in the Handbook of Clinical Neurology¹.

Results: The search identified 33 articles of which 13 were considered relevant. The supplementary search yielded an additional 41 articles. The articles comprised uncontrolled case studies or series; a minority were randomized-controlled trials (RCTs). Sample sizes ranged from 1 to 125. Most studies evaluated non-epileptic seizures and/or functional motor symptoms. Overall, interventions included scripted delivery of the diagnosis, guided self-help, structured psychotherapies, pharmacotherapy, hypnosis, physiotherapy, inpatient treatment, and transcranial magnetic stimulation. Outcome measures consisted predominantly of event frequency, physical and psychological rating scales, and clinical global impression. Objective, performance-based outcome measures, quality of life, and healthcare utilization were less commonly included. Most studies reported some improvement in outcome. RCTs of reasonable sample size supported the efficacy of manualized psychotherapy and physiotherapy.

Conclusions: Challenges in developing recommendations for the treatment of FND include variability in nosology, a paucity of well-conducted RCTs and clinically-relevant outcome measures, and heterogeneity in study populations. Despite these caveats, evidence is accruing for the potential benefit of physical and psychological interventions. The work presented here comprises the initial phase in the development of comprehensive guidelines for FND treatment.

References: ¹Carson A, Hallett M, and Stone J, eds. 2017. Handbook of Clinical Neurology, Functional Neurological Disorders. Vol 138 (3). Elsevier.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/treatment-of-functional-neurological-disorders-towards-expert-consensus-led-guidelines-for-the-american-neuropsychiatric-association-committee-for-research/