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You’ve made the diagnosis of functional neurological disorder: now what?
  1. Caitlin Adams1,2,
  2. Jordan Anderson3,4,
  3. Elizabeth N Madva1,2,
  4. W Curt LaFrance Jr3,4,
  5. David L Perez1,2
  1. 1Functional Neurology Research Group, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Neurology, Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
  4. 4Department of Psychiatry, Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr. David L Perez, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Charlestown, MA 02129, USA; DLPEREZ{at}partners.org

Abstract

Patients with functional neurological disorders (FND)/conversion disorder commonly present to outpatient clinics. FND is now a ‘rule in’ diagnosis based on neurological examination findings and semiological features. While neurologists may be more comfortable diagnosing patients with FND, there is only limited guidance as to how to conduct follow-up outpatient visits. Using clinical vignettes, we provide practical suggestions that may help guide clinical encounters including how to: (1) explore illness beliefs openly; (2) enquire longitudinally about predisposing vulnerabilities, acute precipitants and perpetuating factors that may be further elucidated over time; (3) facilitate psychotherapy engagement by actively listening for potentially unhelpful or maladaptive patterns of thoughts, behaviours, fears or psychosocial stressors that can be reflected back to the patient and (4) enquire about the fidelity of individual treatments and educate other providers who may be less familiar with FND. These suggestions, while important to individualise, provide a blueprint for follow-up FND clinical care.

  • conversion disorder
  • functional movement disorders
  • psychogenic nonepileptic seizures
  • neuropsychiatry

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Footnotes

  • Contributors DLP developed the concept for this article. All authors contributed to the literature review, drafting and critical review of the manuscript.

  • Funding DLP was supported by the Sidney R. Baer Jr. Foundation and the Massachusetts General Hospital Physician-Scientist Development Award.

  • Competing interests WCL has served on the editorial boards of Epilepsia , Epilepsy and Behavior and Journal of Neuropsychiatry and Clinical Neurosciences; receives editor’s royalties from the publication of Gates and Rowan’s Nonepileptic Seizures, 3rd ed. (Cambridge University Press, 2010) and 4th ed. (2017); author’s royalties for Taking Control of Your Seizures: Workbook and Therapist Guide (Oxford University Press, 2015); has received research support from the NIH (NINDS 5K23NS45902 [PI]), Department of Defense, Rhode Island Hospital, the American Epilepsy Society (AES), the Epilepsy Foundation (EF), Brown University and the Siravo Foundation; serves on the Epilepsy Foundation Professional Advisory Board; has received honoraria for the American Academy of Neurology Annual Meeting Annual Course; has served as a clinic development consultant at University of Colorado Denver, Cleveland Clinic, Spectrum Health and Emory University and has provided medico legal expert testimony.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Jon Stone, Edinburgh, UK.

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