Download PDF
Semin Neurol 2022; 42(02): 204-224
DOI: 10.1055/s-0042-1742773
Review Article

Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide

Sara A. Finkelstein  ‡   *
1   Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Caitlin Adams  ‡   *
1   Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
2   Inpatient Psychiatry, Department of Psychiatry, Mass General Brigham Salem Hospital, Salem, Massachusetts
,
Margaret Tuttle 
1   Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
3   Primary Care Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Aneeta Saxena  ‡   **
1   Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
4   Epilepsy Division, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
,
David L. Perez  ‡   **
1   Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
5   Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding D.L.P. was supported by the Sidney R. Baer Jr. Foundation.
› Further Information
    Permissions and Reprints

Abstract

There is a growing body of knowledge regarding management of functional neurological disorder (FND). The aim of this article is to guide the clinician through FND clinical management, from delivery of the diagnosis, to creation of a biopsychosocially-informed treatment plan, to troubleshooting common issues that arise throughout longitudinal care. We review the evidence and core principles of both rehabilitative therapies (physical therapy, occupational therapy, and speech and language therapy) and psychological therapies for the treatment of FND, and discuss the benefits of engaging a multidisciplinary and interdisciplinary team. The optimal timing of specific therapeutic interventions is also discussed, emphasizing a patient-centered perspective. Resources for further reading, for both patients and clinicians, are provided throughout. Additional research is needed to further optimize the therapeutic approach to patients with FND, including the need to develop novel treatments for those that do not positively respond to currently available interventions.

Keywords

functional neurological disorder - functional movement disorder - functional seizures - treatment - neuropsychiatry

* Contributed equally as first authors.


** Contributed equally as senior authors.




Publication History

Article published online:
21 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Stone J, Carson A, Duncan R. et al. Who is referred to neurology clinics? The diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010; 112 (09) 747-751
    CrossrefPubMedGoogle Scholar
  • 2 Ahmad O, Ahmad KE. Functional neurological disorders in outpatient practice: an Australian cohort. J Clin Neurosci 2016; 28: 93-96
    CrossrefPubMedGoogle Scholar
  • 3 Espay AJ, Aybek S, Carson A. et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol 2018; 75 (09) 1132-1141
    CrossrefPubMedGoogle Scholar
  • 4 Baslet G, Bajestan SN, Aybek S. et al. Evidence-based practice for the clinical assessment of psychogenic nonepileptic seizures: a report from the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2021; 33 (01) 27-42
    CrossrefPubMedGoogle Scholar
  • 5 Perez DL, Aybek S, Popkirov S. et al; (On behalf of the American Neuropsychiatric Association Committee for Research. A review and expert opinion on the neuropsychiatric assessment of motor functional neurological disorders. J Neuropsychiatry Clin Neurosci 2021; 33 (01) 14-26
    CrossrefPubMedGoogle Scholar
  • 6 Stone J, Reuber M, Carson A. Functional symptoms in neurology: mimics and chameleons. Pract Neurol 2013; 13 (02) 104-113
    CrossrefPubMedGoogle Scholar
  • 7 Stone J. The bare essentials: functional symptoms in neurology. Pract Neurol 2009; 9 (03) 179-189
    CrossrefPubMedGoogle Scholar
  • 8 Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 2014; 85 (02) 220-226
    CrossrefPubMedGoogle Scholar
  • 9 Stone J. Functional neurological disorders: the neurological assessment as treatment. Pract Neurol 2016; 16 (01) 7-17
    CrossrefPubMedGoogle Scholar
  • 10 Baslet G. Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?. Neuropsychiatr Dis Treat 2012; 8: 585-598
    CrossrefPubMedGoogle Scholar
  • 11 Friedman JH, LaFrance Jr WCJ. Psychogenic disorders: the need to speak plainly. Arch Neurol 2010; 67 (06) 753-755
    CrossrefPubMedGoogle Scholar
  • 12 Farias ST, Thieman C, Alsaadi TM. Psychogenic nonepileptic seizures: acute change in event frequency after presentation of the diagnosis. Epilepsy Behav 2003; 4 (04) 424-429
    CrossrefPubMedGoogle Scholar
  • 13 Kanner AM, Parra J, Frey M, Stebbins G, Pierre-Louis S, Iriarte J. Psychiatric and neurologic predictors of psychogenic pseudoseizure outcome. Neurology 1999; 53 (05) 933-938
    CrossrefPubMedGoogle Scholar
  • 14 Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 2011; 20 (02) 308-311
    CrossrefPubMedGoogle Scholar
  • 15 Carson A, Hallett M, Stone J. Assessment of patients with functional neurologic disorders. In: Hallett M, Stone J, Carson A. eds. Handbook of Clinical Neurology. Vol 139. Elsevier B.V.; 2016: 169-188 DOI: 10.1016/B978-0-12-801772-2.00015-1
    CrossrefGoogle Scholar
  • 16 Stone J, Wojcik W, Durrance D. et al. What should we say to patients with symptoms unexplained by disease? The “number needed to offend”. BMJ 2002; 325 (7378): 1449-1450
    CrossrefPubMedGoogle Scholar
  • 17 Stone J, Edwards M. Trick or treat? Showing patients with functional (psychogenic) motor symptoms their physical signs. Neurology 2012; 79 (03) 282-284
    CrossrefPubMedGoogle Scholar
  • 18 Adams C, Anderson J, Madva EN, LaFrance Jr WC, Perez DL. You've made the diagnosis of functional neurological disorder: now what?. Pract Neurol 2018; 18 (04) 323-330
    CrossrefPubMedGoogle Scholar
  • 19 Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. In: Hallett M, Stone J, Carson A. eds. Handbook of Clinical Neurology. Vol 139. Elsevier B.V.; 2016: 543-553 DOI: 10.1016/B978-0-12-801772-2.00044-8
    CrossrefGoogle Scholar
  • 20 Kanaan R, Armstrong D, Barnes P, Wessely S. In the psychiatrist's chair: how neurologists understand conversion disorder. Brain 2009; 132 (Pt 10): 2889-2896
    CrossrefPubMedGoogle Scholar
  • 21 Davison P, Sharpe M, Wade D, Bass C. “Wheelchair” patients with nonorganic disease: a psychological inquiry. J Psychosom Res 1999; 47 (01) 93-103
    CrossrefPubMedGoogle Scholar
  • 22 Rief W, Nanke A, Emmerich J, Bender A, Zech T. Causal illness attributions in somatoform disorders: associations with comorbidity and illness behavior. J Psychosom Res 2004; 57 (04) 367-371
    PubMedGoogle Scholar
  • 23 Stone J, Binzer M, Sharpe M. Illness beliefs and locus of control: a comparison of patients with pseudoseizures and epilepsy. J Psychosom Res 2004; 57 (06) 541-547
    CrossrefPubMedGoogle Scholar
  • 24 Vargas CM. Dis-sociated. 2019 . URL: https://youtu.be/MA1EYAg9y5k
    PubMedGoogle Scholar
  • 25 Petrie KJ, Müller JT, Schirmbeck F. et al. Effect of providing information about normal test results on patients' reassurance: randomised controlled trial. BMJ 2007; 334 (7589): 352
    CrossrefPubMedGoogle Scholar
  • 26 Wei D, Garlinghouse M, Li W, Swingle N, Samson KK, Taraschenko O. Utilization of brain imaging in evaluating patients with psychogenic nonepileptic spells. Epilepsy Behav 2018; 85: 177-182
    CrossrefPubMedGoogle Scholar
  • 27 Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain 2010; 133 (Pt 5): 1537-1551
    CrossrefPubMedGoogle Scholar
  • 28 Stone J, Carson A, Aditya H. et al. The role of physical injury in motor and sensory conversion symptoms: a systematic and narrative review. J Psychosom Res 2009; 66 (05) 383-390
    CrossrefPubMedGoogle Scholar
  • 29 Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004; 127 (Pt 10): 2360-2372
    CrossrefPubMedGoogle Scholar
  • 30 Voon V, Cavanna AE, Coburn K, Sampson S, Reeve A, LaFrance Jr WC. (On behalf of the American Neuropsychiatric Association Committee for Research). Functional neuroanatomy and neurophysiology of functional neurological disorders (conversion disorder). J Neuropsychiatry Clin Neurosci 2016; 28 (03) 168-190
    CrossrefPubMedGoogle Scholar
  • 31 Saxena A, Paredes-Echeverri S, Michaelis R, Popkirov S, Perez DL. Using the biopsychosocial model to guide patient-centered neurological treatments. Semin Neurol 2022; 42 (02) 80-87
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Fobian AD, Elliott L. A review of functional neurological symptom disorder etiology and the integrated etiological summary model. J Psychiatry Neurosci 2019; 44 (01) 8-18
    CrossrefPubMedGoogle Scholar
  • 33 McKee K, Glass S, Adams C. et al. The inpatient assessment and management of motor functional neurological disorders: an interdisciplinary perspective. Psychosomatics 2018; 59 (04) 358-368
    PubMedGoogle Scholar
  • 34 Carson A, Lehn A. Epidemiology. In: Hallett M, Stone J, Carson A. eds. Handbook of Clinical Neurology. Vol 139. Elsevier B.V.; 2016: 47-60 DOI: 10.1016/B978-0-12-801772-2.00005-9
    CrossrefGoogle Scholar
  • 35 Nielsen G, Stone J, Matthews A. et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry 2015; 86 (10) 1113-1119
    CrossrefPubMedGoogle Scholar
  • 36 Nicholson C, Edwards MJ, Carson AJ. et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry 2020; 91 (10) 1037-1045
    CrossrefPubMedGoogle Scholar
  • 37 Baker J, Barnett C, Cavalli L. et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry 2021; 92 (10) 1112-1125
    CrossrefPubMedGoogle Scholar
  • 38 Nielsen G. Physical treatment of functional neurologic disorders. In: Hallett M, Stone J, Carson A. eds. Handbook of Clinical Neurology. Vol 139. Elsevier B.V.; 2016: 555-569 DOI: 10.1016/B978-0-12-801772-2.00045-X
    CrossrefGoogle Scholar
  • 39 Edwards MJ, Fotopoulou A, Pareés I. Neurobiology of functional (psychogenic) movement disorders. Curr Opin Neurol 2013; 26 (04) 442-447
    CrossrefPubMedGoogle Scholar
  • 40 Pick S, Goldstein LH, Perez DL, Nicholson TR. Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. Published online 2018: 1-8 DOI: 10.1136/jnnp-2018-319201
    CrossrefPubMedGoogle Scholar
  • 41 Pareés I, Kojovic M, Pires C. et al. Physical precipitating factors in functional movement disorders. J Neurol Sci 2014; 338 (1-2): 174-177
    CrossrefPubMedGoogle Scholar
  • 42 Edwards MJ, Adams RA, Brown H, Pareés I, Friston KJ. A Bayesian account of ‘hysteria’. Brain 2012; 135 (Pt 11): 3495-3512
    CrossrefPubMedGoogle Scholar
  • 43 Stone J, Warlow C, Sharpe M. Functional weakness: clues to mechanism from the nature of onset. J Neurol Neurosurg Psychiatry 2012; 83 (01) 67-69
    CrossrefPubMedGoogle Scholar
  • 44 Saxena A, Godena E, Maggio J, Perez DL. Towards an outpatient model of care for motor functional neurological disorders: a neuropsychiatric perspective. Neuropsychiatr Dis Treat 2020; 16: 2119-2134
    CrossrefPubMedGoogle Scholar
  • 45 Frucht L, Perez DL, Callahan J. et al. Functional dystonia: differentiation from primary dystonia and multidisciplinary treatments. Front Neurol 2021; 11: 605262
    CrossrefPubMedGoogle Scholar
  • 46 Gardiner P, MacGregor L, Carson A, Stone J. Occupational therapy for functional neurological disorders: a scoping review and agenda for research. CNS Spectr 2018; 23 (03) 205-212
    CrossrefPubMedGoogle Scholar
  • 47 Ranford J, Perez DL, MacLean J. Additional occupational therapy considerations for functional neurological disorders: a potential role for sensory processing. CNS Spectr 2018; 23 (03) 194-195
    CrossrefPubMedGoogle Scholar
  • 48 Ranford J, MacLean J, Alluri PR. et al. Sensory processing difficulties in functional neurological disorder: a possible predisposing vulnerability?. Psychosomatics 2020; 61 (04) 343-352
    CrossrefPubMedGoogle Scholar
  • 49 Tippett DC, Siebens AA. Distinguishing psychogenic from neurogenic dysfluency when neurologic and psychologic factors coexist. J Fluency Disord 1991; 16 (01) 3-12
    CrossrefPubMedGoogle Scholar
  • 50 Baumgartner J, Duffy JR. Psychogenic stuttering in adults with and without neurologic disease. J Med Speech-Lang Pathol 1997; 5 (02) 75-95
    PubMedGoogle Scholar
  • 51 Deal JL. Sudden onset of stuttering: a case report. J Speech Hear Disord 1982; 47 (03) 301-304
    CrossrefPubMedGoogle Scholar
  • 52 Roth CR, Aronson AE, Davis Jr LJ. Clinical studies in psychogenic stuttering of adult onset. J Speech Hear Disord 1989; 54 (04) 634-646
    CrossrefPubMedGoogle Scholar
  • 53 Brookshire R. A dramatic response to behavior modification by a patient with rapid onset of dysfluent speech. In: Helm-Estabrooks N, Aten J. eds. Difficult Diagnoses in Communication Disorders. College-Hill Press; 1989: 3-12
    Google Scholar
  • 54 Mahr G, Leith W. Psychogenic stuttering of adult onset. J Speech Hear Res 1992; 35 (02) 283-286
    CrossrefPubMedGoogle Scholar
  • 55 Ruotsalainen J, Sellman J, Lehto L, Verbeek J. Systematic review of the treatment of functional dysphonia and prevention of voice disorders. Otolaryngol Head Neck Surg 2008; 138 (05) 557-565
    CrossrefPubMedGoogle Scholar
  • 56 MacKenzie K, Millar A, Wilson JA, Sellars C, Deary IJ. Is voice therapy an effective treatment for dysphonia? A randomised controlled trial. BMJ 2001; 323 (7314): 658-661
    CrossrefPubMedGoogle Scholar
  • 57 Carding PN, Horsley IA, Docherty GJ. A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia. J Voice 1999; 13 (01) 72-104
    CrossrefPubMedGoogle Scholar
  • 58 Gillivan-Murphy P, Drinnan MJ, O'Dwyer TP, Ridha H, Carding P. The effectiveness of a voice treatment approach for teachers with self-reported voice problems. J Voice 2006; 20 (03) 423-431
    CrossrefPubMedGoogle Scholar
  • 59 Simberg S, Sala E, Tuomainen J, Sellman J, Rönnemaa AM. The effectiveness of group therapy for students with mild voice disorders: a controlled clinical trial. J Voice 2006; 20 (01) 97-109
    CrossrefPubMedGoogle Scholar
  • 60 Khalil H, Abushaala A, Stavrakas M. et al. Speech therapy in the treatment of globus pharyngeus: development of a mobile application to improve patient access. Egypt J Ear Nose Throat Allied Sci 2020; 21 (02) 88-93
    CrossrefPubMedGoogle Scholar
  • 61 Wareing M, Elias A, Mitchell D. Management of globus sensation by the speech therapist. Logoped Phoniatr Vocol 1997; 22 (01) 39-42
    CrossrefPubMedGoogle Scholar
  • 62 Khalil HS, Bridger MW, Hilton-Pierce M, Vincent J. The use of speech therapy in the treatment of globus pharyngeus patients: a randomised controlled trial. Rev Laryngol Otol Rhinol (Bord) 2003; 124 (03) 187-190
    PubMedGoogle Scholar
  • 63 Khalil HS, Reddy VM, Bos-Clark M. et al. Speech therapy in the treatment of globus pharyngeus: how we do it. Clin Otolaryngol 2011; 36 (04) 388-392
    CrossrefPubMedGoogle Scholar
  • 64 Millichap F, Lee M, Pring T. A lump in the throat: Should speech and language therapists treat globus pharyngeus?. Disabil Rehabil 2005; 27 (03) 124-130
    CrossrefPubMedGoogle Scholar
  • 65 Duffy JR. Functional speech disorders: clinical manifestations, diagnosis, and management. In: Hallett M, Stone J, Carson A. eds. Handbook of Clinical Neurology. Vol 139. Elsevier B.V.; 2016: 379-388 DOI: 10.1016/B978-0-12-801772-2.00033-3
    CrossrefGoogle Scholar
  • 66 Freeburn J. Speech therapy: being understood clearly. In: LaFaver K, Maurer C, Nicholson TR, Perez DL. eds. Functional Movement Disorder: An Interdisciplinary Case-Based Approach. Springer International Publishing; 2022: 341-352
    Google Scholar
  • 67 Baker J. The role of psychogenic and psychosocial factors in the development of functional voice disorders. Int J Speech Lang Pathol 2008; 10 (04) 210-230
    CrossrefPubMedGoogle Scholar
  • 68 Gasparini S, Beghi E, Ferlazzo E. et al. Management of psychogenic non-epileptic seizures: a multidisciplinary approach. Eur J Neurol 2019; 26 (02) 205-e15
    CrossrefPubMedGoogle Scholar
  • 69 Libbon R, Gadbaw J, Watson M. et al. The feasibility of a multidisciplinary group therapy clinic for the treatment of nonepileptic seizures. Epilepsy Behav 2019; 98 (Pt A): 117-123
    CrossrefPubMedGoogle Scholar
  • 70 Terry D, Enciso L, Trott K, Burch MM, Albert DVF. Outcomes in children and adolescents with psychogenic nonepileptic events using a multidisciplinary clinic approach. J Child Neurol 2020; 35 (13) 918-923
    CrossrefPubMedGoogle Scholar
  • 71 Malhi P, Kumar C, Singhi P, Sankhyan N. Outcome of conversion symptoms in children. Indian J Pediatr 2021; 88 (04) 367-369
    CrossrefPubMedGoogle Scholar
  • 72 Hubschmid M, Aybek S, Maccaferri GE. et al. Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks. Gen Hosp Psychiatry 2015; 37 (05) 448-455
    CrossrefPubMedGoogle Scholar
  • 73 Cope SR, Smith JG, Edwards MJ, Holt K, Agrawal N. Enhancing the communication of functional neurological disorder diagnosis: a multidisciplinary education session. Eur J Neurol 2021; 28 (01) 40-47
    CrossrefPubMedGoogle Scholar
  • 74 Jacob AE, Smith CA, Jablonski ME. et al. Multidisciplinary clinic for functional movement disorders (FMD): 1-year experience from a single centre. J Neurol Neurosurg Psychiatry 2018; 89 (09) 1011-1012
    CrossrefPubMedGoogle Scholar
  • 75 LaFaver K. Treatment of functional movement disorders. Neurol Clin 2020; 38 (02) 469-480
    CrossrefPubMedGoogle Scholar
  • 76 Jordbru AA, Smedstad LM, Klungsøyr O, Martinsen EW. Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up. J Rehabil Med 2014; 46 (02) 181-187
    CrossrefPubMedGoogle Scholar
  • 77 Hsieh Y, Deshpande S. A therapy-led, multidisciplinary programme for treatment-resistant functional fixed dystonia. BMJ Case Rep 2020; 13 (07) e235213
    CrossrefPubMedGoogle Scholar
  • 78 FitzGerald TL, Southby AK, Haines TP, Hough JP, Skinner EH. Is physiotherapy effective in the management of child and adolescent conversion disorder? A systematic review. J Paediatr Child Health 2015; 51 (02) 159-167
    CrossrefPubMedGoogle Scholar
  • 79 Bolger A, Collins A, Michels M, Pruitt D. Characteristics and outcomes of children with conversion disorder admitted to a single inpatient rehabilitation unit: a retrospective study. PM R 2018; 10 (09) 910-916
    CrossrefPubMedGoogle Scholar
  • 80 Kozlowska K, Nicola G, Stephen S, Blanche S. Psychologically informed physiotherapy as part of a multidisciplinary rehabilitation program for children and adolescents with functional neurological disorder: physical and mental health outcomes. J Paediatr Child Health 2021; 57 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 81 Gutkin M, McLean L, Brown R, Kanaan RA. Systematic review of psychotherapy for adults with functional neurological disorder. J Neurol Neurosurg Psychiatry 2020; 92 (01) 36-44
    CrossrefPubMedGoogle Scholar
  • 82 Tolchin B, Baslet G, Suzuki J. et al. Randomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures. Epilepsia 2019; 60 (05) 986-995
    CrossrefPubMedGoogle Scholar
  • 83 Tolchin B, Dworetzky BA, Martino S, Blumenfeld H, Hirsch LJ, Baslet G. Adherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures. Neurology 2019; 92 (07) e675-e679
    CrossrefPubMedGoogle Scholar
  • 84 Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques - facilitating behaviour change in the general practice setting. Aust Fam Physician 2012; 41 (09) 660-667
    PubMedGoogle Scholar
  • 85 Sharpe M, Walker J, Williams C. et al. Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology 2011; 77 (06) 564-572
    CrossrefPubMedGoogle Scholar
  • 86 Espay AJ, Ries S, Maloney T. et al. Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology 2019; 93 (19) e1787-e1798
    CrossrefPubMedGoogle Scholar
  • 87 Goldstein LH, Robinson EJ, Mellers JDC. et al; CODES Study Group. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry 2020; 7 (06) 491-505
    CrossrefPubMedGoogle Scholar
  • 88 LaFrance Jr WC, Ho WLN, Bhatla A, Baird GL, Altalib HH, Godleski L. Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth. Epilepsia 2020; 61 (11) 2572-2582
    CrossrefPubMedGoogle Scholar
  • 89 LaFrance Jr WC, Baird GL, Barry JJ. et al; NES Treatment Trial (NEST-T) Consortium. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry 2014; 71 (09) 997-1005
    CrossrefPubMedGoogle Scholar
  • 90 Dozois DJ, Dobson KS, Rnic K. Historical and philosophical bases of cognitive behavioral theories. In: Dobson KS, Dozois DJ. eds. Handbook of Cognitive Behavioral Therapies. 4th ed.. Guildford Press; 2019: 3-31
    Google Scholar
  • 91 Williams C, Carson A, Smith S, Kent C, Sharpe M. Overcoming Functional Neurological Symptoms: A Five Areas Approach. Routledge; 2011
    Google Scholar
  • 92 LaFrance Jr WC, Wincze JP. Treating Nonepileptic Seizures: Therapist Guide. Oxford University Press; 2015
    CrossrefGoogle Scholar
  • 93 Sharma VD, Jones R, Factor SA. Psychodynamic psychotherapy for functional (psychogenic) movement disorders. J Mov Disord 2017; 10 (01) 40-44
    CrossrefPubMedGoogle Scholar
  • 94 Blagys MD, Hilsenroth MJ. Distinctive features of short-term psychodynamic-interpersonal psychotherapy: a review of the comparative psychotherapy process literature. Clin Psychol Sci Pract 2000; 7 (02) 167-188
    CrossrefPubMedGoogle Scholar
  • 95 Brown RJ. Psychodynamic Therapy for FND. In: FNDSociety.Org Lecture Series. FND Society; 2020
    Google Scholar
  • 96 Kabat-Zinn J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Hyperion; 1994
    Google Scholar
  • 97 Baslet G, Ehlert A, Oser M, Dworetzky BA. Mindfulness-based therapy for psychogenic nonepileptic seizures. Epilepsy Behav 2020; 103 (Pt A) DOI: 10.1016/j.yebeh.2019.106534.
    CrossrefPubMedGoogle Scholar
  • 98 Park ER, Traeger L, Vranceanu AM. et al. The development of a patient-centered program based on the relaxation response: the Relaxation Response Resiliency Program (3RP). Psychosomatics 2013; 54 (02) 165-174
    CrossrefPubMedGoogle Scholar
  • 99 Goodman M, Carpenter D, Tang CY. et al. Dialectical behavior therapy alters emotion regulation and amygdala activity in patients with borderline personality disorder. J Psychiatr Res 2014; 57 (01) 108-116
    CrossrefPubMedGoogle Scholar
  • 100 Bullock KD, Mirza N, Forte C, Trockel M. Group dialectical-behavior therapy skills training for conversion disorder with seizures. J Neuropsychiatry Clin Neurosci 2015; 27 (03) 240-243
    CrossrefPubMedGoogle Scholar
  • 101 Alluri PR, Solit J, Leveroni CL. et al. Cognitive complaints in motor functional neurological (conversion) disorders: a focused review and clinical perspective. Cogn Behav Neurol 2020; 33 (02) 77-89
    CrossrefPubMedGoogle Scholar
  • 102 Stone J, Pal S, Blackburn D, Reuber M, Thekkumpurath P, Carson A. Functional (psychogenic) cognitive disorders: a perspective from the neurology clinic. J Alzheimers Dis 2015; 48 (Suppl. 01) S5-S17
    CrossrefPubMedGoogle Scholar
  • 103 Ball HA, McWhirter L, Ballard C. et al. Functional cognitive disorder: dementia's blind spot. Brain 2020; 143 (10) 2895-2903
    CrossrefPubMedGoogle Scholar
  • 104 McWhirter L, Ritchie C, Stone J, Carson A. Functional cognitive disorders: a systematic review. Lancet Psychiatry 2020; 7 (02) 191-207
    CrossrefPubMedGoogle Scholar
  • 105 Myers L, Vaidya-Mathur U, Lancman M. Prolonged exposure therapy for the treatment of patients diagnosed with psychogenic non-epileptic seizures (PNES) and post-traumatic stress disorder (PTSD). Epilepsy Behav 2017; 66: 86-92
    CrossrefPubMedGoogle Scholar
  • 106 Chemali Z, Meadows ME. The use of eye movement desensitization and reprocessing in the treatment of psychogenic seizures. Epilepsy Behav 2004; 5 (05) 784-787
    CrossrefPubMedGoogle Scholar
  • 107 Conwill M, Oakley L, Evans K, Cavanna AE. CBT-based group therapy intervention for nonepileptic attacks and other functional neurological symptoms: a pilot study. Epilepsy Behav 2014; 34: 68-72
    CrossrefPubMedGoogle Scholar
  • 108 Stone J, Hoeritzauer I, Brown K, Carson A. Therapeutic sedation for functional (psychogenic) neurological symptoms. J Psychosom Res 2014; 76 (02) 165-168
    CrossrefPubMedGoogle Scholar
  • 109 Moene FC, Spinhoven P, Hoogduin KAL, van Dyck R. A randomised controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for in-patients with conversion disorder of the motor type. Psychother Psychosom 2002; 71 (02) 66-76
    CrossrefPubMedGoogle Scholar
  • 110 Moene FC, Spinhoven P, Hoogduin KAL, van Dyck R. A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn 2003; 51 (01) 29-50
    CrossrefPubMedGoogle Scholar
  • 111 Deeley Q. Hypnosis as a model of functional neurologic disorders. In: Hallett M, Stone J, Carson A. eds. Handbook of Clinical Neurology. Vol 139. Elsevier B.V.; 2016: 95-103 DOI: 10.1016/B978-0-12-801772-2.00009-6
    CrossrefGoogle Scholar
  • 112 Matin N, Young SS, Williams B. et al. Neuropsychiatric associations with gender, illness duration, work disability, and motor subtype in a U.S. functional neurological disorders clinic population. J Neuropsychiatry Clin Neurosci 2017; 29 (04) 375-382
    CrossrefPubMedGoogle Scholar
  • 113 Glass SP, Matin N, Williams B. et al. Neuropsychiatric factors linked to adherence and short-term outcome in a U.S. functional neurological disorders clinic: a retrospective cohort study. J Neuropsychiatry Clin Neurosci 2018; 30 (02) 152-159
    CrossrefPubMedGoogle Scholar
  • 114 Nicholson TRJ, Voon V. Transcranial magnetic stimulation and sedation as treatment for functional neurologic disorders. In: Hallett M, Stone J, Carson A. eds. Handbook of Clinical Neurology. Vol 139. Elsevier B.V.; 2016: 619-629 DOI: 10.1016/B978-0-12-801772-2.00050-3
    CrossrefGoogle Scholar
  • 115 McWhirter L, Ludwig L, Carson A, McIntosh RD, Stone J. Transcranial magnetic stimulation as a treatment for functional (psychogenic) upper limb weakness. J Psychosom Res 2016; 89: 102-106
    CrossrefPubMedGoogle Scholar
  • 116 Pick S, Hodsoll J, Stanton B. et al. Trial Of Neurostimulation In Conversion Symptoms (TONICS): a feasibility randomised controlled trial of transcranial magnetic stimulation for functional limb weakness. BMJ Open 2020; 10 (10) e037198
    CrossrefPubMedGoogle Scholar
  • 117 Vizcarra JA, Lopez-Castellanos JR, Dwivedi AK, Schmerler DA, Ries S, Espay AJ. OnabotulinumtoxinA and cognitive behavioral therapy in functional dystonia: a pilot randomized clinical trial. Parkinsonism Relat Disord 2019; 63: 174-178
    CrossrefPubMedGoogle Scholar
  • 118 Sa DS, Mailis-Gagnon A, Nicholson K, Lang AE. Posttraumatic painful torticollis. Mov Disord 2003; 18 (12) 1482-1491
    CrossrefPubMedGoogle Scholar
  • 119 Frei KP, Pathak M, Jenkins S, Truong DD. Natural history of posttraumatic cervical dystonia. Mov Disord 2004; 19 (12) 1492-1498
    CrossrefPubMedGoogle Scholar
  • 120 Dreissen YEM, Dijk JM, Gelauff JM. et al. Botulinum neurotoxin treatment in jerky and tremulous functional movement disorders: a double-blind, randomised placebo-controlled trial with an open-label extension. J Neurol Neurosurg Psychiatry 2019; 90 (11) 1244-1250
    CrossrefPubMedGoogle Scholar
  • 121 Edwards MJ, Bhatia KP, Cordivari C. Immediate response to botulinum toxin injections in patients with fixed dystonia. Mov Disord 2011; 26 (05) 917-918
    CrossrefPubMedGoogle Scholar
  • 122 Stone J, Carson A. Functional neurologic symptoms: assessment and management. Neurol Clin 2011; 29 (01) 1-18 , vii
    CrossrefPubMedGoogle Scholar
  • 123 Howard L, Wessely S, Leese M. et al. Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache. J Neurol Neurosurg Psychiatry 2005; 76 (11) 1558-1564
    CrossrefPubMedGoogle Scholar
  • 124 Perez DL, Keshavan MS, Scharf JM, Boes AD, Price BH. Bridging the great divide: What can neurology learn from psychiatry?. J Neuropsychiatry Clin Neurosci 2018; 30 (04) 271-278
    CrossrefPubMedGoogle Scholar
  • 125 Maggio JB, Ospina JP, Callahan J, Hunt AL, Stephen CD, Perez DL. Outpatient physical therapy for functional neurological disorder: a preliminary feasibility and naturalistic outcome study in a U.S. cohort. J Neuropsychiatry Clin Neurosci 2020; 32 (01) 85-89
    CrossrefPubMedGoogle Scholar
  • 126 Finkelstein SA, Cortel-LeBlanc MA, Cortel-LeBlanc A, Stone J. Functional neurological disorder in the emergency department. Acad Emerg Med 2021; 28 (06) 685-696
    CrossrefPubMedGoogle Scholar
  • 127 Jacob AE, Kaelin DL, Roach AR, Ziegler CH, LaFaver K. Motor retraining (MoRe) for functional movement disorders: outcomes from a 1-week multidisciplinary rehabilitation program. PM R 2018; 10 (11) 1164-1172
    CrossrefPubMedGoogle Scholar
  • 128 Walzl D, Solomon AJ, Stone J. Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap. J Neurol 2021; DOI: 10.1007/s00415-021-10436-6.
    CrossrefPubMedGoogle Scholar
  • 129 Walzl D, Carson AJ, Stone J. The misdiagnosis of functional disorders as other neurological conditions. J Neurol 2019; 266 (08) 2018-2026
    CrossrefPubMedGoogle Scholar
  • 130 Scheepers B, Clough P, Pickles C. The misdiagnosis of epilepsy: findings of a population study. Seizure 1998; 7 (05) 403-406
    CrossrefPubMedGoogle Scholar
  • 131 Solomon AJ, Klein E. Disclosing a misdiagnosis of multiple sclerosis: do no harm?. Continuum (Minneap Minn) 2013; 19 (4 Multiple Sclerosis): 1087-1091
    PubMedGoogle Scholar
  • 132 Tyrer P, Tyrer H. Health anxiety: detection and treatment. BJPsych Adv 2018; 24 (01) 66-72
    CrossrefPubMedGoogle Scholar
  • 133 Salkovskis PM, Warwick HMC, Deale AC. Cognitive-behavioral treatment for severe and persistent health anxiety (hypochondriasis). Brief Treat Crisis Interv 2003; 3 (03) 353-368
    CrossrefPubMedGoogle Scholar
  • 134 Lempert T, Dieterich M, Huppert D, Brandt T. Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand 1990; 82 (05) 335-340
    CrossrefPubMedGoogle Scholar
  • 135 Stone J, Carson A, Duncan R. et al. Which neurological diseases are most likely to be associated with “symptoms unexplained by organic disease”. J Neurol 2012; 259 (01) 33-38
    CrossrefPubMedGoogle Scholar
  • 136 National Institute for Health and Care Excellence. NICE Guideline - Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. Published online 2021 1-36
    PubMedGoogle Scholar
  • 137 Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep 2016; 65 (1, No. RR-1): 1-49
    CrossrefPubMedGoogle Scholar
  • 138 Skljarevski V, Zhang S, Iyengar S. et al. Efficacy of duloxetine in patients with chronic pain conditions. Curr Drug Ther 2011; 6 (04) 296-303
    CrossrefPubMedGoogle Scholar
  • 139 Jimenez XF, Aboussouan A, Johnson J. Functional neurological disorder responds favorably to interdisciplinary rehabilitation models. Psychosomatics 2019; 60 (06) 556-562
    CrossrefPubMedGoogle Scholar
  • 140 Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008; 4 (05) 487-504
    Google Scholar
  • 141 Jalilianhasanpour R, Williams B, Gilman I. et al. Resilience linked to personality dimensions, alexithymia and affective symptoms in motor functional neurological disorders. J Psychosom Res 2018; 107 (January): 55-61
    CrossrefPubMedGoogle Scholar
  • 142 Demartini B, Bombieri F, Goeta D, Gambini O, Ricciardi L, Tinazzi M. A physical therapy programme for functional motor symptoms: a telemedicine pilot study. Parkinsonism Relat Disord 2020; 76: 108-111
    CrossrefPubMedGoogle Scholar
  • 143 Nielsen G, Buszewicz M, Stevenson F. et al. Randomised feasibility study of physiotherapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatry 2017; 88 (06) 484-490
    CrossrefPubMedGoogle Scholar
  • 144 Matthews A, Brown M, Stone J. Inpatient physiotherapy for functional (psychogenic) gait disorder: a case series of 35 patients. Mov Disord Clin Pract (Hoboken) 2016; 3 (06) 603-606
    CrossrefPubMedGoogle Scholar
  • 145 Nielsen G, Ricciardi L, Demartini B, Hunter R, Joyce E, Edwards MJ. Outcomes of a 5-day physiotherapy programme for functional (psychogenic) motor disorders. J Neurol 2015; 262 (03) 674-681
    CrossrefPubMedGoogle Scholar
  • 146 Espay AJ, Edwards MJ, Oggioni GD. et al. Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor. Parkinsonism Relat Disord 2014; 20 (06) 647-650
    CrossrefPubMedGoogle Scholar
  • 147 Ferrara J, Stamey W, Strutt AM, Adam OR, Jankovic J. Transcutaneous electrical stimulation (TENS) for psychogenic movement disorders. J Neuropsychiatry Clin Neurosci 2011; 23 (02) 141-148
    CrossrefPubMedGoogle Scholar
  • 148 Dallocchio C, Arbasino C, Klersy C, Marchioni E. The effects of physical activity on psychogenic movement disorders. Mov Disord 2010; 25 (04) 421-425
    CrossrefPubMedGoogle Scholar
  • 149 Hebert C, Behel JM, Pal G, Kasi R, Kompoliti K. Multidisciplinary inpatient rehabilitation for functional movement disorders: a prospective study with long term follow up. Parkinsonism Relat Disord 2021; 82: 50-55
    CrossrefPubMedGoogle Scholar
  • 150 Petrochilos P, Elmalem MS, Patel D. et al. Outcomes of a 5-week individualised MDT outpatient (day-patient) treatment programme for functional neurological symptom disorder (FNSD). J Neurol 2020; 267 (09) 2655-2666
    CrossrefPubMedGoogle Scholar
  • 151 Dallocchio C, Tinazzi M, Bombieri F, Arnó N, Erro R. Cognitive behavioural therapy and adjunctive physical activity for functional movement disorders (Conversion Disorder): a pilot, single-blinded, randomized study. Psychother Psychosom 2016; 85 (06) 381-383
    CrossrefPubMedGoogle Scholar
  • 152 McCormack R, Moriarty J, Mellers JD. et al. Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study. J Neurol Neurosurg Psychiatry 2014; 85 (08) 895-900
    CrossrefPubMedGoogle Scholar
  • 153 Demartini B, Batla A, Petrochilos P, Fisher L, Edwards MJ, Joyce E. Multidisciplinary treatment for functional neurological symptoms: a prospective study. J Neurol 2014; 261 (12) 2370-2377
    CrossrefPubMedGoogle Scholar
  • 154 Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR, Ahlskog JE. Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol. Parkinsonism Relat Disord 2012; 18 (03) 247-251
    CrossrefPubMedGoogle Scholar
  • 155 Saifee TA, Kassavetis P, Pareés I. et al. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol 2012; 259 (09) 1958-1963
    CrossrefPubMedGoogle Scholar
  • 156 Heruti RJ, Reznik J, Adunski A, Levy A, Weingarden H, Ohry A. Conversion motor paralysis disorder: analysis of 34 consecutive referrals. Spinal Cord 2002; 40 (07) 335-340
    CrossrefPubMedGoogle Scholar
  • 157 Speed J. Behavioral management of conversion disorder: retrospective study. Arch Phys Med Rehabil 1996; 77 (02) 147-154
    CrossrefPubMedGoogle Scholar
  • 158 Butz C, Iske C, Truba N, Trott K. Treatment of functional gait abnormality in a rehabilitation setting: emphasizing the physical interventions for treating the whole child. Innov Clin Neurosci 2019; 16 (7-08): 18-21
    PubMedGoogle Scholar
  • 159 Reuber M. The etiology of psychogenic non-epileptic seizures: toward a biopsychosocial model. Neurol Clin 2009; 27 (04) 909-924
    CrossrefPubMedGoogle Scholar
  • 160 McKee K, Glass S, Adams C. et al. The inpatient assessment and management of motor functional neurological disorders: an interdisciplinary perspective. Psychosomatics 2018; 59 (04) 358-368
    CrossrefPubMedGoogle Scholar