Multidisciplinarity

It is currently assumed, based on (neuro)scientific research, that FND is triggered and maintained by a combination of biological, psychological, sociological and spiritual factors. The complexity of the disorder makes it important to plan multidisciplinary treatment, with a simultaneous 'patient-centred' individual approach.

A multidisciplinary approach to treatment is useful for patients with motor functional neurological disorders, especially when additional symptoms such as chronic fatigue, sleep disturbances, pain, cognitive problems and/or any associated psychological disorder (e.g. Studies on the effectiveness of multidisciplinary treatment are scarce, as it is very difficult to provide equivalent conditions, given that patients vary widely in the type of symptoms, outcomes, duration and setting of treatment, as well as in the professional composition of the multidisciplinary team (Finkelstein et al, 2022).

The role of the personal doctor

---

The GP plays an important role in identifying the symptoms of a functional neurological disorder, initially clarifying the presumptive diagnosis and the reasons for referral to a neurologist. It is a good idea to ask patients about the presence of acute and chronic pain, episodes of dissociation, headache (migraine), fatigue, sleep disturbances and cognitive problems, as all symptoms are present in the FND population and have a major impact on the patient's quality of life. It is important to be aware that most patients had/have bad experiences with healthcare professionals, so try to use therapeutic language and try to make the patient feel heard and accepted (Bennett et al., 2021). 

• Resources

  • Bennett, K., Diamond, C., Hoeritzauer, I., Gardiner, P., McWhirter, L., Carson, A., in Stone, J. (2021). A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine, 21(1), 28.

  • LaFaver, K., LaFrance, W. C., Price, M. E., Rosen, P. B., and Rapaport, M. (2021). Treatment of functional neurological disorder: current status, future directions, and a research agenda. CNS Spectrums, 26(6), 607-613.

  • Finkelstein, S. A., Adams, C., Tuttle, M., Saxena, A., and Perez, D. L. (2022). Neuropsychiatric treatment approaches for functional neurological disorder: a how to guide. In Seminars in Neurology (Vol. 42, No. 02, pp. 204-224). Thieme Medical Publishers, Inc..

  • Pick, S., Goldstein, L. H., Perez, D. L., and Nicholson, T. R. (2019). Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. Journal of Neurology, Neurosurgery & Psychiatry, 90(6), 704-711.

  • Saxena, A., in Perez, D. L. (2021). A transdiagnostic and biopsychosocial-informed perspective across functional seizures and functional movement disorder. Epilepsy & Behavior, 117.