Setting up Functional Neurological Disorder Treatment Services : Questions and Answers - 18/07/23

Doi : 10.1016/j.ncl.2023.04.002

Sara A. Finkelstein, MD, MSc, FRCPC ^a,^⁎ , Alan Carson, MBChB, MPhil, MD, FRCPsych, FRCP ^b, Mark J. Edwards, MBBS, PhD ^c, Kasia Kozlowska, MBBS, FRANZCP, PhD ^d, Sarah C. Lidstone, MD, PhD, FRCPC ^e, David L. Perez, MD, MMSc ^f, Ginger Polich, MD, MS ^g, Jon Stone, MBChB, FRCP, PhD ^b, Selma Aybek, MD ^h
^a Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA
^b Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, 50 Little France Cres, Edinburgh EH16 4SA, UK
^c Institute of Psychiatry, Psychology and Neuroscience, King’s College 16 De Crespigny Park, London, SE5 8AF, UK
^d Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead Institute for Medical Research, Psychological Medicine, The Children’s Hospital at Westmead, Cn Hawkesbury Road, Hainsworth Street, Westmead, NSW 2145, Australia
^e Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Centre, Room 3-131, 550 University Avenue, Toronto ON M5G 2A2, Canada
^f Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
^g Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women’s Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, MA 02129, USA
^h Faculté des Sciences et de Médecine, Université de Fribourg, Bureau 2.106d, Chemin du Musée 5, 1700 Fribourg, Suisse

^∗Corresponding author. Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.Massachusetts General Hospital55 Fruit StreetBostonMA02114

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Résumé

Functional neurologic disorder (FND) is commonly encountered across outpatient and inpatient medical settings. Given the potential for a high burden of disability in some patients and mounting evidence for the efficacy of FND-specific multidisciplinary treatment services, expanding clinical services for this population is a necessity. In this perspective article, we discuss considerations for creating FND services, including the types of services that exist, how to start, how to identify appropriate referrals, and how to develop and monitor individualized treatment plans. In addition, we discuss how this effort can be done sustainably – balancing patient needs with limited healthcare resources.

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Keywords : Functional neurological disorder, Functional movement disorder, Functional seizures, Non-epileptic seizures, Functional cognitive disorder, Persistent postural perceptual dizziness, Treatment