Some suggested ingredients for a therapeutic explanation for patients with functional neurological disorders
| Ingredient | Example |
|---|---|
| Explain what they do have… | “You have functional weakness” “You have dissociative seizures” |
| Emphasise the mechanism of the symptoms rather than the cause | Weakness: “There is a problem with the way your brain is sending messages to your body—its a problem with the function of your nervous system” Seizures: “You are going into a trance-like state a bit like someone being hypnotised” |
| Explain how you made the diagnosis | Show the patient their Hoover's sign or dissociative seizure video |
| Indicate that you believe them | “I do not think you are imagining/making up your symptoms/mad” |
| Emphasise that it is common | “I see lots of patients with similar symptoms” |
| Emphasise reversibility | “Because there is no damage, you have the potential to get better” |
| Explain what they do not have | “You don't have multiple sclerosis, epilepsy”, etc |
| Emphasise that self-help is a key part of getting better | “This is not your fault but there are things you can do to help it get better” |
| Metaphors may be useful | “There's a problem with the software of the nervous system rather than the hardware” |
| Introducing the role of depression/anxiety | “If you have been feeling stressed/low/worried, that will tend to make the symptoms even worse” (often easier to achieve on a second visit) |
| Use written information | Send the patient their clinic letter. Give them some written information, eg, http://www.neurosymptom.org, http://www.nonepilepticattacks.info |
| Stop the antiepileptic drug in dissociative seizures | If you have diagnosed dissociative (non-epileptic) attacks and not epilepsy, stop the antiepileptic drug |
| See the patient again | “I'll see you again. Please have a read of my letter and the information I have given you and come back with questions” |
| Making the physiotherapy or psychiatric referral (preferably at a second visit) | “My colleague X (or my colleague Dr X) has a lot of experience and interest in helping patients with functional movement disorder—he won't think you are crazy either” |