Functional neurological disorders: the neurological assessment as treatment

Stone, Jon

doi:10.1136/practneurol-2015-001241

Cited by 126 publications

(118 citation statements)

References 52 publications

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“…12,13 Neurologists, rather than GPs or psychiatrists, may indeed be well placed to take on this role of "treatment maintenance" for both practical and medical reasons. 35,36 From a practical standpoint, neurology services, although limited, are more readily available than neuropsychiatric and psychotherapeutic services, 19 whereas general psychiatrists have little interest or expertise in the management of these patients, 37,38 and access to appropriate psychological treatments can be limited. 19 These resource limitations, and the fact that neurologists tend to make the diagnosis of functional seizures, may explain why GPs felt more comfortable referring to, and better supported by, neurologic compared with psychiatric services.…”

Section: Discussionmentioning

confidence: 99%

“…36 Neurologists may also help to mitigate concerns about overlooked neurologic symptoms, and in doing so help patients to come to terms with their diagnosis and to engage in forms of psychological treatment. 35,39 Despite these advantages, and the fact that GPs reported being better supported by neurology compared to psychiatry, 21.8% of GPs still reported being very poorly or poorly supported by neurology services. This is not surprising because nationally 53% of neurologists do not follow-up patients with functional seizures, at least until anticonvulsants are withdrawn and seizures controlled, and indeed 20% discharge patients directly after making a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Functional seizures: An evaluation of the attitudes of general practitioners local to a tertiary neuroscience service in London

et al. 2018

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Summary Objective Functional seizures are a common functional neurologic disorder. Given their chronic nature, and the biopsychosocial factors involved in their etiology, general practitioners (GPs) play a crucial role in the care of these patients. However, little is known about the attitudes of GPs toward, and knowledge of, functional seizures. Methods The Atkinson Morley Regional Neuroscience Centre in London provides a comprehensive service to patients with functional seizures. As part of a service evaluation we conducted an online survey among local GPs over a 1‐month period assessing their attitudes toward, and knowledge of, functional seizures. Results One hundred twenty of 974 surveyed GPs replied to the survey (12.3%). Approximately 75% of GPs readily use the term “pseudoseizures,” and over 50% were not sure or did not think that functional seizures were involuntary. Nearly 30% believed, or were unsure as to whether, functional seizures occur only when patients are stressed. Despite approximately 50% of GPs expressing interest in getting involved in the management of these patients, a similar proportion do not feel confident in dealing with queries from patients with functional seizures. Although most GPs felt that neurology and psychiatry should be the primary caregivers in the diagnosis and management, respectively, of functional seizures, 50% were also of the opinion that neurology should be involved in the management of these patients. Significance This survey highlights the attitudes of, and descriptive terms used by, GPs toward patients with functional seizures. Our findings suggest a need for better and clearer provision of information to GPs about this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Functional seizures: An evaluation of the attitudes of general practitioners local to a tertiary neuroscience service in London

et al. 2018

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“…Because the disclosure of diagnosis can be complex, the use of a standardized non-judgmental script, such as outlined by Stone (51) as well as external review of the delivery of that script should be a critical part of ongoing training efforts. A video repository demonstrating strategies of delivering the diagnosis and communication with the patient could be integrated into training.…”

Section: Approaches To Disrupt Boundaries Reduce Stigma and Advancementioning

confidence: 99%

Disentangling Stigma from Functional Neurological Disorders: Conference Report and Roadmap for the Future

et al. 2017

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A multidisciplinary expert review of key issues and future directions from the conference “Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms.”On October 9 and 10, 2015, a conference entitled “Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms” was held at the Center for Ethics, Emory University, Atlanta, GA, USA. This conference brought together a select group of 30 distinguished thought leaders and practitioners, including ethicists, researchers, clinicians, humanities scholars, and advocates to discuss the unique challenges and controversies related to the diagnosis, treatment, and stigma for patients with what is currently recognized as functional (“psychogenic”) neurological disorders. Our group of experts explored the conflicts and ethical tensions within health care that must be addressed in order to advance care for these disorders. What follows is a reflection on the conversations between conference attendees outlining key challenges and value conflicts in the diagnosis and treatment of patients with functional disorders. With this report, we aim to provide a roadmap for reducing stigma and improving care for functional neurological disorders (FND). A path forward would involve (1) setting a multifactorial research agenda that equally prioritized access to effective psychotherapy as well as identification of novel biomarkers; (2) empowering patients with FND to be heard and to drive changes in care; and (3) reducing isolation for clinicians by providing formal training and setting up multidisciplinary care teams and support networks.

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“…Management of FND, regardless of which specific symptoms are present, begins with a comprehensive assessment of the range of symptoms present, followed by explanation and discussion of the diagnosis [2]. People with FND are often polysymptomatic, and although it takes time, assessment of all the symptoms present is essential for an effective consultation and for planning future management.…”

Section: Diagnostic Explanation and General Principles Of Managementmentioning

confidence: 99%

“…This replaces a traditional neurological approach of excluding a neurological disease process and either discharging the patient or referring to a psychiatrist. Instead, an extended role for neurologists can include a specific expertise in the diagnosis of FND, diagnostic explanation, treatment and follow-up, often acting as coordinator for a multidisciplinary team-based approach to management [2]. There may be comorbid psychiatric disorders present, and thus a coordinated effort between a neurologist and psychiatrist is important for both assessment and management on a case by case basis.…”

Section: Introductionmentioning

confidence: 99%

Management of functional neurological disorder

et al. 2020

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Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. These symptoms are varied and include abnormal control of movement, episodes of altered awareness resembling epileptic seizures and abnormal sensation and are often comorbid with chronic pain, fatigue and cognitive symptoms. There is increasing evidence for the role of neurologists in both the assessment and management of FND. The aim of this review is to discuss strategies for the management of FND by focusing on the diagnostic discussion and general principles, as well as specific treatment strategies for various FND symptoms, highlighting the role of the neurologist and proposing a structure for an interdisciplinary FND service.

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Functional neurological disorders: the neurological assessment as treatment

Cited by 126 publications

References 52 publications

Functional seizures: An evaluation of the attitudes of general practitioners local to a tertiary neuroscience service in London

Functional seizures: An evaluation of the attitudes of general practitioners local to a tertiary neuroscience service in London

Disentangling Stigma from Functional Neurological Disorders: Conference Report and Roadmap for the Future

Management of functional neurological disorder

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