Zaburzenie neurologiczne czynnościowe / zaburzenie konwersyjne

Zaburzenie neurologiczne czynnościowe / zaburzenie konwersyjne
Rokowania, prognozy i postęp choroby

Zaburzenie neurologiczne czynnościowe (FND) charakteryzuje się objawami neurologicznymi niewyjaśnionymi przez choroby organiczne, z ogólnie niekorzystnym rokowaniem. Dane wskazują, że około 39% pacjentów pozostaje w tym samym stanie lub ulega pogorszeniu, a około 80% pozostaje objawowych w długoterminowej obserwacji. W badaniu prospektywnym na 716 pacjentach 68% miało niekorzystne wyniki po roku, a tylko 20% pacjentów z FND motorycznym osiągnęło całkowitą remisję. Pozytywne czynniki prognostyczne to wczesna diagnoza, młody wiek, akceptacja diagnozy, brak współistniejących zaburzeń psychicznych oraz intensywna rehabilitacja szpitalna. Negatywne predyktory obejmują długi czas trwania objawów przed diagnozą, opóźnienie w poszukiwaniu pomocy, odrzucanie diagnozy, słabą komunikację z personelem medycznym, nieprzestrzeganie leczenia oraz współistniejące zaburzenia psychiczne i poznawcze. Traumatyczne doświadczenia z dzieciństwa, takie jak przemoc fizyczna (OR 3,9) i seksualna (OR 3,3), również pogarszają rokowanie.

<a href="#prognoza-zaburzenia-neurologicznego-czynnosciowego”>Prognoza zaburzenia neurologicznego czynnościowego / zaburzenia konwersyjnego

Ogólne rokowanie
Czynniki prognostyczne pozytywne
Czynniki prognostyczne negatywne
Wpływ historii traumy na rokowanie
Znaczenie wczesnej interwencji i właściwego podejścia diagnostycznego
Wpływ leczenia na rokowanie
Potencjalne konsekwencje nieleczonego FND
Najlepszy scenariusz prognostyczny
Wyzwania systemowe w leczeniu FND
Wnioski dotyczące rokowania
Kolejne rozdziały

neurologicznego-czynnosciowego”>Prognoza zaburzenia neurologicznego czynnościowego / zaburzenia konwersyjnego

Zaburzenie neurologiczne czynnościowe (FND, ang. Functional Neurological Disorder), nazywane również zaburzeniem konwersyjnym, jest powszechnym i upośledzającym schorzeniem o znaczącym wpływie społeczno-ekonomicznym. Charakteryzuje się objawami neurologicznymi, których nie można wyjaśnić chorobą neurologiczną ani innym schorzeniem medycznym.¹²³ Przewidywanie długoterminowych wyników leczenia FND jest kluczowe dla odpowiedzi na pytania pacjentów i ich opiekunów, określenia zasadności leczenia oraz identyfikacji czynników prognostycznych.⁴

Ogólne rokowanie

Dostępne dane wskazują, że rokowanie w zaburzeniach neurologicznych czynnościowych jest na ogół niekorzystne. W większości badań funkcjonalne objawy ruchowe oraz psychogenne napady niepadaczkowe pozostają niezmienione lub ulegają pogorszeniu u większości pacjentów podczas obserwacji kontrolnej.⁵ Systematyczny przegląd długoterminowych badań follow-up wykazał, że 39% pacjentów z FND pozostaje w tym samym stanie lub doświadcza pogorszenia, a większość (około 80%) pozostaje objawowa.⁶

Jedno z badań prospektywnych, obejmujące 716 pacjentów obserwowanych przez rok w Szkocji, wykazało niekorzystne wyniki u 68% uczestników, przy czym 67% pacjentów miało niezmienione objawy lub pogorszenie.⁷ W innym badaniu stwierdzono, że tylko 20% pacjentów wykazało całkowitą remisję podczas długoterminowej obserwacji FND o charakterze motorycznym, 40% osiągnęło częściową poprawę, a pozostałe 40% doświadczyło stabilizacji lub pogorszenia objawów.⁸

Czynniki prognostyczne pozytywne

Identyfikacja pozytywnych czynników prognostycznych może pomóc w ukierunkowaniu leczenia i zwiększeniu szans na korzystny wynik. Badania wskazują na następujące czynniki pozytywne:

Wczesna diagnoza – jest kluczowa dla zapobiegania chronifikacji objawów i zwiększenia szans na powrót do zdrowia.⁹¹⁰¹¹
Młody wiek pacjenta w momencie diagnozy sugeruje lepsze rokowanie.¹²
Akceptacja diagnozy i dobre zrozumienie zaburzenia przez pacjenta są związane z lepszymi wynikami.¹³
Brak współistniejących zaburzeń psychicznych prognozuje dobry długoterminowy wynik leczenia.¹⁴
Intensywna rehabilitacja szpitalna w przypadku FND o charakterze motorycznym może być skuteczna i przynosić korzystne długoterminowe rezultaty.¹⁵

Czynniki prognostyczne negatywne

Zidentyfikowano również czynniki związane z gorszym rokowaniem:

Długi czas trwania objawów przed diagnozą jest najbardziej wyraźnym negatywnym predyktorem.¹⁶
Opóźnienie w poszukiwaniu pomocy medycznej zmniejsza szansę na korzystny wynik.¹⁷
Odrzucanie diagnozy przez pacjenta i nieprzyjmowanie do wiadomości istnienia tego zaburzenia.¹⁸
Słaba relacja i komunikacja z personelem medycznym wpływa negatywnie na proces leczenia.¹⁹
Nieprzestrzeganie zalecanego planu leczenia.²⁰
Przewlekłe objawy FND u dzieci w momencie prezentacji.²¹
Zaburzenia poznawcze jako czynnik zwiększający podatność.²²
Współistniejące zaburzenia psychiczne lub inne funkcjonalne objawy somatyczne, które nie ustępują.²³
Rozwój przewlekłych problemów zdrowia psychicznego.²⁴

Wyniki badań dotyczących wpływu postępowań sądowych i świadczeń socjalnych na rokowanie są niejednoznaczne – niektóre badania wskazują na negatywny wpływ tych czynników, podczas gdy inne nie wykazały ich znaczenia dla końcowego wyniku.²⁵

Wpływ historii traumy na rokowanie

Przegląd systematyczny i meta-analiza wykazały, że prawdopodobieństwo diagnozy FND było 3,9 razy wyższe u osób, które doświadczyły fizycznej przemocy w dzieciństwie, i 3,3 razy wyższe u osób po doświadczeniach wykorzystania seksualnego w dzieciństwie, w porównaniu z grupą kontrolną.²⁶ Te traumatyczne doświadczenia mogą komplikować proces terapeutyczny i wpływać na długoterminowe rokowanie.

Znaczenie wczesnej interwencji i właściwego podejścia diagnostycznego

Obecne zalecenia dotyczące FND podkreślają wagę podejścia do diagnozy jako procesu potwierdzania FND, a nie wyłącznie wykluczania innych stanów.²⁷ Wczesna diagnoza i leczenie, szczególnie edukacja dotycząca tego zaburzenia, mogą pomóc w powrocie do zdrowia.²⁸

Po ustaleniu diagnozy, lekarz powinien omówić FND z pacjentem w sposób nieoceniający.²⁹ Pacjentom należy przekazać informację, że FND jest powszechnym i uleczalnym schorzeniem, a całkowity powrót do zdrowia jest możliwy.³⁰ Lepsza specyficzność diagnostyczna ułatwia neurologom przedstawienie diagnozy pacjentom, co stanowi pierwszy krok w leczeniu.³¹

Wpływ leczenia na rokowanie

Ostatnia dekada przyniosła pierwsze randomizowane badania kontrolowane dotyczące fizjoterapii, rehabilitacji multidyscyplinarnej i psychoterapii w FND, wraz z zaleceniami dotyczącymi fizjoterapii, terapii zajęciowej i miar wynikowych.³² Nowe międzynarodowe rekomendacje i opinie ekspertów sugerują, że terapia FND powinna być dostosowanym, multidyscyplinarnym postępowaniem angażującym neurologa, fizjoterapeutę, a w większości przypadków również psychoterapeutę/psychiatrę.³³

Skuteczne opcje terapeutyczne obejmują:

Fizjoterapię (PT) i terapię zajęciową (OT) – badania dokumentują ich skuteczność w kierowaniu niezależnymi czynnościami życia codziennego.³⁴
Terapię poznawczo-behawioralną (CBT) – skupia się na roli, jaką poznanie i zachowanie odgrywają w podtrzymywaniu FND poprzez nieprzystosowawcze automatyczne myśli, błędną interpretację bodźców sensorycznych i przekonania dotyczące choroby.³⁵
Intensywne programy szpitalne – trwające na przykład trzy tygodnie, zgodnie z aktualnymi dowodami z wyspecjalizowanych ośrodków na całym świecie.³⁶

Kilka badań dotyczących leczenia szpitalnego i ambulatoryjnego (głównie, choć nie wyłącznie, multidyscyplinarnego) wykazało, że większość pacjentów doświadcza znacznej poprawy funkcji fizycznych i jakości życia.³⁷

Potencjalne konsekwencje nieleczonego FND

Niektóre objawy zaburzenia neurologicznego czynnościowego, szczególnie jeśli nie są leczone, mogą prowadzić do znacznej niepełnosprawności i obniżenia jakości życia, podobnie jak problemy spowodowane schorzeniami medycznymi lub chorobami.³⁸ FND może mieć poważny wpływ na życie pacjenta, w zależności od występujących objawów. Wiele osób cierpiących na to zaburzenie doświadcza ciężkich objawów, które uniemożliwiają im pracę lub wykonywanie ulubionych czynności.³⁹

Najlepszy scenariusz prognostyczny

Najlepszym możliwym wynikiem w zaburzeniu konwersyjnym jest całkowity powrót do zdrowia. Wraz z poprawą zdrowia psychicznego i dobrostanu pacjenta, zakłócenia w funkcjonowaniu mózgu powinny się poprawiać i stawać coraz mniej zauważalne, aż do całkowitego ustąpienia.⁴⁰ Jeśli diagnoza wskazuje na zaburzenie neurologiczne czynnościowe, odpowiednie leczenie może złagodzić objawy i pomóc zapobiec przyszłym problemom.⁴¹

Wyzwania systemowe w leczeniu FND

Brak zainteresowania i inwestycji w FND przez systemy opieki zdrowotnej w końcu XX wieku znajduje odzwierciedlenie w niezwykle małej liczbie programów opieki dla tej populacji, co z kolei sprawia, że pacjenci czują się marginalizowani i nie mają dostępu do odpowiednich terapii.⁴² Ten systemowy problem może dodatkowo wpływać na ogólnie niekorzystne rokowanie w tej grupie pacjentów.

Wnioski dotyczące rokowania

Podsumowując, rokowanie w zaburzeniu neurologicznym czynnościowym / zaburzeniu konwersyjnym jest zróżnicowane, ale generalnie stanowi wyzwanie terapeutyczne. Najlepsze rokowanie mają pacjenci z wczesną diagnozą, w młodym wieku, akceptujący diagnozę, bez współistniejących zaburzeń psychicznych, poddawani intensywnej, multidyscyplinarnej terapii. Z kolei długotrwałe objawy przed diagnozą, odrzucanie diagnozy, brak współpracy terapeutycznej i współistniejące zaburzenia psychiczne są związane z gorszym rokowaniem. Mimo ogólnie niekorzystnych statystyk dotyczących długoterminowych wyników, odpowiednie podejście diagnostyczne i terapeutyczne może znacząco poprawić rokowanie i jakość życia pacjentów z FND.⁴³⁴⁴⁴⁵

Kolejne rozdziały

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Materiały źródłowe

#1 Functional neurologic disorder/conversion disorder – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197
Functional neurologic disorder a newer and broader term that includes what some people call conversion disorder features nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. […] Early diagnosis and treatment, especially education about the condition, can help with recovery. […] If the diagnosis is functional neurologic disorder, treatment may improve the symptoms and help prevent future problems. […] Some symptoms of functional neurologic disorder, particularly if not treated, can result in substantial disability and poor quality of life, similar to problems caused by medical conditions or disease.
#2 Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic
https://www.mdpi.com/2514-183X/6/1/2
Functional neurological disorder (FND) represent a common disorder with significant socio-economic impact. […] New international recommendation and expert opinions suggest that therapy of FND should be a tailored multidisciplinary management involving the neurologist, the physiotherapist, and in most cases the psychotherapist/psychiatrist. […] A definitive diagnosis is made by the team of neurologists (three neurologists, two residents) on the basis of clinical positive signs and after careful exclusion of an alternate possible neurological disease explaining the symptom. […] According to the largest prospective follow-up study in mixed FNDs (cohort study of 716 patients followed up over one year in Scotland), 68 outcomes were poor with 67% of the patients having unchanged symptoms or worse.
#3 :: JCN :: Journal of Clinical Neurology
https://thejcn.com/DOIx.php?id=10.3988/jcn.2023.0246
Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. […] The long-term prognosis of FND is reportedly poor, and it differs with the clinical presentation. One study found that only 20% of patients exhibited complete remission during a long-term follow-up (FU) of motor FND, with 40% exhibiting partial recovery and 40% experiencing stabilization or worsening of symptoms. […] The present study found that the absence of a comorbid psychiatric disorder did predict a good long-term outcome, which is consistent with the findings of Binzer and Kullgren. […] In conclusion, intensive inpatient rehabilitation for motor FND is effective and produces favorable long-term results. The absence of a comorbid psychiatric condition is a predictor of a good long-term outcome.
#4 Prognosis of functional neurologic disorders – PubMed
https://pubmed.ncbi.nlm.nih.gov/27719869/
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients’ and carers’ questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. […] With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. […] Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. […] Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
#5 Prognosis of functional neurologic disorders – PubMed
https://pubmed.ncbi.nlm.nih.gov/27719869/
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients’ and carers’ questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. […] With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. […] Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. […] Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
#6 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Regarding prognosis, a systemic review of long-term follow-up studies from 10 to 491 individuals reported that 39% of patients across the spectrum of FND were the same or worse and the majority (approximately 80%) remained symptomatic. […] Outcomes are less favourable for children with chronic mFND symptoms at presentation; those with cognitive vulnerabilities, whose comorbid mental health disorders or other (comorbid) functional somatic symptoms do not resolve and those who subsequently develop chronic mental health problems.
#7 Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic
https://www.mdpi.com/2514-183X/6/1/2
Functional neurological disorder (FND) represent a common disorder with significant socio-economic impact. […] New international recommendation and expert opinions suggest that therapy of FND should be a tailored multidisciplinary management involving the neurologist, the physiotherapist, and in most cases the psychotherapist/psychiatrist. […] A definitive diagnosis is made by the team of neurologists (three neurologists, two residents) on the basis of clinical positive signs and after careful exclusion of an alternate possible neurological disease explaining the symptom. […] According to the largest prospective follow-up study in mixed FNDs (cohort study of 716 patients followed up over one year in Scotland), 68 outcomes were poor with 67% of the patients having unchanged symptoms or worse.
#8 :: JCN :: Journal of Clinical Neurology
https://thejcn.com/DOIx.php?id=10.3988/jcn.2023.0246
Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. […] The long-term prognosis of FND is reportedly poor, and it differs with the clinical presentation. One study found that only 20% of patients exhibited complete remission during a long-term follow-up (FU) of motor FND, with 40% exhibiting partial recovery and 40% experiencing stabilization or worsening of symptoms. […] The present study found that the absence of a comorbid psychiatric disorder did predict a good long-term outcome, which is consistent with the findings of Binzer and Kullgren. […] In conclusion, intensive inpatient rehabilitation for motor FND is effective and produces favorable long-term results. The absence of a comorbid psychiatric condition is a predictor of a good long-term outcome.
#9 Prognosis of functional neurologic disorders – PubMed
https://pubmed.ncbi.nlm.nih.gov/27719869/
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients’ and carers’ questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. […] With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. […] Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. […] Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
#10 Functional neurologic disorder/conversion disorder – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197
Functional neurologic disorder a newer and broader term that includes what some people call conversion disorder features nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. […] Early diagnosis and treatment, especially education about the condition, can help with recovery. […] If the diagnosis is functional neurologic disorder, treatment may improve the symptoms and help prevent future problems. […] Some symptoms of functional neurologic disorder, particularly if not treated, can result in substantial disability and poor quality of life, similar to problems caused by medical conditions or disease.
#11 Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic
https://www.mdpi.com/2514-183X/6/1/2
However, several other studies with in- and outpatient treatment (mostly not exclusively multidisciplinary) have shown that the majority of patients experience a significant improvement in physical function and quality of life. […] Early diagnosis is important to prevent chronification. […] According to available studies and our own experience, early diagnosis and acceptance, as well as a good understanding of the disorder by the patient, are associated with a better outcome. […] With this goal in mind, we have been offering since this year an intensive in-patient program for three weeks according to current evidence of other worldwide specialized centers.
#12 Prognosis of functional neurologic disorders – PubMed
https://pubmed.ncbi.nlm.nih.gov/27719869/
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients’ and carers’ questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. […] With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. […] Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. […] Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
#13 Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic
https://www.mdpi.com/2514-183X/6/1/2
However, several other studies with in- and outpatient treatment (mostly not exclusively multidisciplinary) have shown that the majority of patients experience a significant improvement in physical function and quality of life. […] Early diagnosis is important to prevent chronification. […] According to available studies and our own experience, early diagnosis and acceptance, as well as a good understanding of the disorder by the patient, are associated with a better outcome. […] With this goal in mind, we have been offering since this year an intensive in-patient program for three weeks according to current evidence of other worldwide specialized centers.
#14 :: JCN :: Journal of Clinical Neurology
https://thejcn.com/DOIx.php?id=10.3988/jcn.2023.0246
Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. […] The long-term prognosis of FND is reportedly poor, and it differs with the clinical presentation. One study found that only 20% of patients exhibited complete remission during a long-term follow-up (FU) of motor FND, with 40% exhibiting partial recovery and 40% experiencing stabilization or worsening of symptoms. […] The present study found that the absence of a comorbid psychiatric disorder did predict a good long-term outcome, which is consistent with the findings of Binzer and Kullgren. […] In conclusion, intensive inpatient rehabilitation for motor FND is effective and produces favorable long-term results. The absence of a comorbid psychiatric condition is a predictor of a good long-term outcome.
#15 :: JCN :: Journal of Clinical Neurology
https://thejcn.com/DOIx.php?id=10.3988/jcn.2023.0246
Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. […] The long-term prognosis of FND is reportedly poor, and it differs with the clinical presentation. One study found that only 20% of patients exhibited complete remission during a long-term follow-up (FU) of motor FND, with 40% exhibiting partial recovery and 40% experiencing stabilization or worsening of symptoms. […] The present study found that the absence of a comorbid psychiatric disorder did predict a good long-term outcome, which is consistent with the findings of Binzer and Kullgren. […] In conclusion, intensive inpatient rehabilitation for motor FND is effective and produces favorable long-term results. The absence of a comorbid psychiatric condition is a predictor of a good long-term outcome.
#16 Prognosis of functional neurologic disorders – PubMed
https://pubmed.ncbi.nlm.nih.gov/27719869/
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients’ and carers’ questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. […] With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. […] Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. […] Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
#17 Conversion Disorder: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17975-conversion-disorder
Conversion disorder is a condition that can have major effects on your life, depending on the symptoms you have. Many people who have it experience severe symptoms that keep them from working or doing activities they enjoy. […] Many people with conversion disorder are less likely to have a good outcome when the following happen: If they delay seeking medical care. If they refuse to believe they have this condition. If they don’t have a good relationship and communication with their healthcare provider. If they don’t follow the treatment plan their healthcare provider recommends. […] The best-case outcome with conversion disorder is a complete recovery. As a person improves their mental health and well-being, the disruptions in their brain should improve and become less noticeable until they’re gone entirely.
#18 Conversion Disorder: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17975-conversion-disorder
Conversion disorder is a condition that can have major effects on your life, depending on the symptoms you have. Many people who have it experience severe symptoms that keep them from working or doing activities they enjoy. […] Many people with conversion disorder are less likely to have a good outcome when the following happen: If they delay seeking medical care. If they refuse to believe they have this condition. If they don’t have a good relationship and communication with their healthcare provider. If they don’t follow the treatment plan their healthcare provider recommends. […] The best-case outcome with conversion disorder is a complete recovery. As a person improves their mental health and well-being, the disruptions in their brain should improve and become less noticeable until they’re gone entirely.
#19 Conversion Disorder: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17975-conversion-disorder
Conversion disorder is a condition that can have major effects on your life, depending on the symptoms you have. Many people who have it experience severe symptoms that keep them from working or doing activities they enjoy. […] Many people with conversion disorder are less likely to have a good outcome when the following happen: If they delay seeking medical care. If they refuse to believe they have this condition. If they don’t have a good relationship and communication with their healthcare provider. If they don’t follow the treatment plan their healthcare provider recommends. […] The best-case outcome with conversion disorder is a complete recovery. As a person improves their mental health and well-being, the disruptions in their brain should improve and become less noticeable until they’re gone entirely.
#20 Conversion Disorder: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17975-conversion-disorder
Conversion disorder is a condition that can have major effects on your life, depending on the symptoms you have. Many people who have it experience severe symptoms that keep them from working or doing activities they enjoy. […] Many people with conversion disorder are less likely to have a good outcome when the following happen: If they delay seeking medical care. If they refuse to believe they have this condition. If they don’t have a good relationship and communication with their healthcare provider. If they don’t follow the treatment plan their healthcare provider recommends. […] The best-case outcome with conversion disorder is a complete recovery. As a person improves their mental health and well-being, the disruptions in their brain should improve and become less noticeable until they’re gone entirely.
#21 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Regarding prognosis, a systemic review of long-term follow-up studies from 10 to 491 individuals reported that 39% of patients across the spectrum of FND were the same or worse and the majority (approximately 80%) remained symptomatic. […] Outcomes are less favourable for children with chronic mFND symptoms at presentation; those with cognitive vulnerabilities, whose comorbid mental health disorders or other (comorbid) functional somatic symptoms do not resolve and those who subsequently develop chronic mental health problems.
#22 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Regarding prognosis, a systemic review of long-term follow-up studies from 10 to 491 individuals reported that 39% of patients across the spectrum of FND were the same or worse and the majority (approximately 80%) remained symptomatic. […] Outcomes are less favourable for children with chronic mFND symptoms at presentation; those with cognitive vulnerabilities, whose comorbid mental health disorders or other (comorbid) functional somatic symptoms do not resolve and those who subsequently develop chronic mental health problems.
#23 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Regarding prognosis, a systemic review of long-term follow-up studies from 10 to 491 individuals reported that 39% of patients across the spectrum of FND were the same or worse and the majority (approximately 80%) remained symptomatic. […] Outcomes are less favourable for children with chronic mFND symptoms at presentation; those with cognitive vulnerabilities, whose comorbid mental health disorders or other (comorbid) functional somatic symptoms do not resolve and those who subsequently develop chronic mental health problems.
#24 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Regarding prognosis, a systemic review of long-term follow-up studies from 10 to 491 individuals reported that 39% of patients across the spectrum of FND were the same or worse and the majority (approximately 80%) remained symptomatic. […] Outcomes are less favourable for children with chronic mFND symptoms at presentation; those with cognitive vulnerabilities, whose comorbid mental health disorders or other (comorbid) functional somatic symptoms do not resolve and those who subsequently develop chronic mental health problems.
#25 Prognosis of functional neurologic disorders – PubMed
https://pubmed.ncbi.nlm.nih.gov/27719869/
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients’ and carers’ questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. […] With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. […] Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. […] Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
#26 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurologypsychiatry intersection. […] This decade has seen the first randomised controlled trials for physiotherapy, multidisciplinary rehabilitation and psychotherapy performed in the field, with consensus recommendations for physiotherapy, occupational therapy and outcome measures also published. […] Improved diagnostic specificity has made it easier for neurologists to present the diagnosis to patients, which is the first step in treatment. […] A systematic review and meta-analysis showed that the odds of being diagnosed with FND was 3.9 times higher given childhood physical abuse compared with controls and 3.3 times higher given childhood sexual abuse. […] The late 20th century’s lack of interest and investment in mFND by healthcare systems is reflected in exceedingly few care programmes for this population, which in turn is reflected in patients feeling marginalised and unable to access treatments.
#27 Diagnosing Functional Neurological Disorder through History and Physical Examination: A Case Report | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/72763-diagnosing-functional-neurological-disorder-through-history-and-physical-examination-a-case-report
Functional neurological disorder (FND) is a common and disabling condition, with a prevalence of 50 per 100,000 people and 4 to 5 per 100000 population per year, specifically for motor FND. […] The current recommendation on FND is to approach the diagnosis as a process of ruling in FND rather than simply ruling out other conditions. […] Once a diagnosis is made, the provider should be careful to discuss FND with the patient nonjudgmentally. […] The patient was reassured that having FND is common and treatable and that she has the potential for complete recovery. […] Treatment options for FND include limiting hands-on treatment, fostering adaptive motor function, redirecting attention, using sequential learning, gradually eliminating external supports, and encouraging self-management.
#28 Functional neurologic disorder/conversion disorder – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197
Functional neurologic disorder a newer and broader term that includes what some people call conversion disorder features nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. […] Early diagnosis and treatment, especially education about the condition, can help with recovery. […] If the diagnosis is functional neurologic disorder, treatment may improve the symptoms and help prevent future problems. […] Some symptoms of functional neurologic disorder, particularly if not treated, can result in substantial disability and poor quality of life, similar to problems caused by medical conditions or disease.
#29 Diagnosing Functional Neurological Disorder through History and Physical Examination: A Case Report | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/72763-diagnosing-functional-neurological-disorder-through-history-and-physical-examination-a-case-report
Functional neurological disorder (FND) is a common and disabling condition, with a prevalence of 50 per 100,000 people and 4 to 5 per 100000 population per year, specifically for motor FND. […] The current recommendation on FND is to approach the diagnosis as a process of ruling in FND rather than simply ruling out other conditions. […] Once a diagnosis is made, the provider should be careful to discuss FND with the patient nonjudgmentally. […] The patient was reassured that having FND is common and treatable and that she has the potential for complete recovery. […] Treatment options for FND include limiting hands-on treatment, fostering adaptive motor function, redirecting attention, using sequential learning, gradually eliminating external supports, and encouraging self-management.
#30 Diagnosing Functional Neurological Disorder through History and Physical Examination: A Case Report | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/72763-diagnosing-functional-neurological-disorder-through-history-and-physical-examination-a-case-report
Functional neurological disorder (FND) is a common and disabling condition, with a prevalence of 50 per 100,000 people and 4 to 5 per 100000 population per year, specifically for motor FND. […] The current recommendation on FND is to approach the diagnosis as a process of ruling in FND rather than simply ruling out other conditions. […] Once a diagnosis is made, the provider should be careful to discuss FND with the patient nonjudgmentally. […] The patient was reassured that having FND is common and treatable and that she has the potential for complete recovery. […] Treatment options for FND include limiting hands-on treatment, fostering adaptive motor function, redirecting attention, using sequential learning, gradually eliminating external supports, and encouraging self-management.
#31 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurologypsychiatry intersection. […] This decade has seen the first randomised controlled trials for physiotherapy, multidisciplinary rehabilitation and psychotherapy performed in the field, with consensus recommendations for physiotherapy, occupational therapy and outcome measures also published. […] Improved diagnostic specificity has made it easier for neurologists to present the diagnosis to patients, which is the first step in treatment. […] A systematic review and meta-analysis showed that the odds of being diagnosed with FND was 3.9 times higher given childhood physical abuse compared with controls and 3.3 times higher given childhood sexual abuse. […] The late 20th century’s lack of interest and investment in mFND by healthcare systems is reflected in exceedingly few care programmes for this population, which in turn is reflected in patients feeling marginalised and unable to access treatments.
#32 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurologypsychiatry intersection. […] This decade has seen the first randomised controlled trials for physiotherapy, multidisciplinary rehabilitation and psychotherapy performed in the field, with consensus recommendations for physiotherapy, occupational therapy and outcome measures also published. […] Improved diagnostic specificity has made it easier for neurologists to present the diagnosis to patients, which is the first step in treatment. […] A systematic review and meta-analysis showed that the odds of being diagnosed with FND was 3.9 times higher given childhood physical abuse compared with controls and 3.3 times higher given childhood sexual abuse. […] The late 20th century’s lack of interest and investment in mFND by healthcare systems is reflected in exceedingly few care programmes for this population, which in turn is reflected in patients feeling marginalised and unable to access treatments.
#33 Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic
https://www.mdpi.com/2514-183X/6/1/2
Functional neurological disorder (FND) represent a common disorder with significant socio-economic impact. […] New international recommendation and expert opinions suggest that therapy of FND should be a tailored multidisciplinary management involving the neurologist, the physiotherapist, and in most cases the psychotherapist/psychiatrist. […] A definitive diagnosis is made by the team of neurologists (three neurologists, two residents) on the basis of clinical positive signs and after careful exclusion of an alternate possible neurological disease explaining the symptom. […] According to the largest prospective follow-up study in mixed FNDs (cohort study of 716 patients followed up over one year in Scotland), 68 outcomes were poor with 67% of the patients having unchanged symptoms or worse.
#34 Diagnosing Functional Neurological Disorder through History and Physical Examination: A Case Report | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/72763-diagnosing-functional-neurological-disorder-through-history-and-physical-examination-a-case-report
Several studies have documented the effectiveness of physical therapy (PT) and occupational therapy (OT) in using principles to guide independent activities of daily functioning and living. […] Cognitive behavioral therapy (CBT) is another critical component of treatment that focuses on the role that cognition and behavior play in sustaining FND through maladaptive automatic thoughts, misinterpretation of sensory input, and illness beliefs. […] In conclusion, the current case demonstrates the difficulty in establishing a diagnosis of FND when the presenting symptoms are similar to a stroke.
#35 Diagnosing Functional Neurological Disorder through History and Physical Examination: A Case Report | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/72763-diagnosing-functional-neurological-disorder-through-history-and-physical-examination-a-case-report
Several studies have documented the effectiveness of physical therapy (PT) and occupational therapy (OT) in using principles to guide independent activities of daily functioning and living. […] Cognitive behavioral therapy (CBT) is another critical component of treatment that focuses on the role that cognition and behavior play in sustaining FND through maladaptive automatic thoughts, misinterpretation of sensory input, and illness beliefs. […] In conclusion, the current case demonstrates the difficulty in establishing a diagnosis of FND when the presenting symptoms are similar to a stroke.
#36 Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic
https://www.mdpi.com/2514-183X/6/1/2
However, several other studies with in- and outpatient treatment (mostly not exclusively multidisciplinary) have shown that the majority of patients experience a significant improvement in physical function and quality of life. […] Early diagnosis is important to prevent chronification. […] According to available studies and our own experience, early diagnosis and acceptance, as well as a good understanding of the disorder by the patient, are associated with a better outcome. […] With this goal in mind, we have been offering since this year an intensive in-patient program for three weeks according to current evidence of other worldwide specialized centers.
#37 Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic
https://www.mdpi.com/2514-183X/6/1/2
However, several other studies with in- and outpatient treatment (mostly not exclusively multidisciplinary) have shown that the majority of patients experience a significant improvement in physical function and quality of life. […] Early diagnosis is important to prevent chronification. […] According to available studies and our own experience, early diagnosis and acceptance, as well as a good understanding of the disorder by the patient, are associated with a better outcome. […] With this goal in mind, we have been offering since this year an intensive in-patient program for three weeks according to current evidence of other worldwide specialized centers.
#38 Functional neurologic disorder/conversion disorder – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197
Functional neurologic disorder a newer and broader term that includes what some people call conversion disorder features nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. […] Early diagnosis and treatment, especially education about the condition, can help with recovery. […] If the diagnosis is functional neurologic disorder, treatment may improve the symptoms and help prevent future problems. […] Some symptoms of functional neurologic disorder, particularly if not treated, can result in substantial disability and poor quality of life, similar to problems caused by medical conditions or disease.
#39 Conversion Disorder: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17975-conversion-disorder
Conversion disorder is a condition that can have major effects on your life, depending on the symptoms you have. Many people who have it experience severe symptoms that keep them from working or doing activities they enjoy. […] Many people with conversion disorder are less likely to have a good outcome when the following happen: If they delay seeking medical care. If they refuse to believe they have this condition. If they don’t have a good relationship and communication with their healthcare provider. If they don’t follow the treatment plan their healthcare provider recommends. […] The best-case outcome with conversion disorder is a complete recovery. As a person improves their mental health and well-being, the disruptions in their brain should improve and become less noticeable until they’re gone entirely.
#40 Conversion Disorder: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17975-conversion-disorder
Conversion disorder is a condition that can have major effects on your life, depending on the symptoms you have. Many people who have it experience severe symptoms that keep them from working or doing activities they enjoy. […] Many people with conversion disorder are less likely to have a good outcome when the following happen: If they delay seeking medical care. If they refuse to believe they have this condition. If they don’t have a good relationship and communication with their healthcare provider. If they don’t follow the treatment plan their healthcare provider recommends. […] The best-case outcome with conversion disorder is a complete recovery. As a person improves their mental health and well-being, the disruptions in their brain should improve and become less noticeable until they’re gone entirely.
#41 Functional neurologic disorder/conversion disorder – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197
Functional neurologic disorder a newer and broader term that includes what some people call conversion disorder features nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. […] Early diagnosis and treatment, especially education about the condition, can help with recovery. […] If the diagnosis is functional neurologic disorder, treatment may improve the symptoms and help prevent future problems. […] Some symptoms of functional neurologic disorder, particularly if not treated, can result in substantial disability and poor quality of life, similar to problems caused by medical conditions or disease.
#42 Decade of progress in motor functional neurological disorder: continuing the momentum | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/92/6/668
Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurologypsychiatry intersection. […] This decade has seen the first randomised controlled trials for physiotherapy, multidisciplinary rehabilitation and psychotherapy performed in the field, with consensus recommendations for physiotherapy, occupational therapy and outcome measures also published. […] Improved diagnostic specificity has made it easier for neurologists to present the diagnosis to patients, which is the first step in treatment. […] A systematic review and meta-analysis showed that the odds of being diagnosed with FND was 3.9 times higher given childhood physical abuse compared with controls and 3.3 times higher given childhood sexual abuse. […] The late 20th century’s lack of interest and investment in mFND by healthcare systems is reflected in exceedingly few care programmes for this population, which in turn is reflected in patients feeling marginalised and unable to access treatments.
#43 Prognosis of functional neurologic disorders – PubMed
https://pubmed.ncbi.nlm.nih.gov/27719869/
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients’ and carers’ questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. […] With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. […] Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. […] Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
#44 Management of Functional Neurological Disorders (FND): Experience from a Swiss FND Clinic
https://www.mdpi.com/2514-183X/6/1/2
However, several other studies with in- and outpatient treatment (mostly not exclusively multidisciplinary) have shown that the majority of patients experience a significant improvement in physical function and quality of life. […] Early diagnosis is important to prevent chronification. […] According to available studies and our own experience, early diagnosis and acceptance, as well as a good understanding of the disorder by the patient, are associated with a better outcome. […] With this goal in mind, we have been offering since this year an intensive in-patient program for three weeks according to current evidence of other worldwide specialized centers.
#45 :: JCN :: Journal of Clinical Neurology
https://thejcn.com/DOIx.php?id=10.3988/jcn.2023.0246
Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. […] The long-term prognosis of FND is reportedly poor, and it differs with the clinical presentation. One study found that only 20% of patients exhibited complete remission during a long-term follow-up (FU) of motor FND, with 40% exhibiting partial recovery and 40% experiencing stabilization or worsening of symptoms. […] The present study found that the absence of a comorbid psychiatric disorder did predict a good long-term outcome, which is consistent with the findings of Binzer and Kullgren. […] In conclusion, intensive inpatient rehabilitation for motor FND is effective and produces favorable long-term results. The absence of a comorbid psychiatric condition is a predictor of a good long-term outcome.