Abstract
Functional neurological disorder (FND) represent a common disorder with significant socio-economic impact. In this context and alongside recent new neuroscientific insights, FND attracts a growing interest both in clinical practice and academic activities. 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 first decisive step is the establishment of a definitive diagnosis, based on the presence of clinical positive signs during neurological assessment together with a clear communication and explanation of the diagnosis by the neurologist. A second important step is based on individual therapeutic sessions, involving different disciplines (neurology and psychotherapy or neurology and physiotherapy). Comorbidities, such as pain or fatigue and psychiatric comorbidities (anxiety, depression, dissociation etc.) should be carefully evaluated, as they need an individualized treatment path. New FND clinics have been created worldwide over the last decades to offer such multidisciplinary settings and this article will present the experience of a first Swiss FND clinic created in 2016. The aim is to highlight in the form of a narrative review the current literature supporting the usefulness and importance of FND clinics, by reviewing the latest evidence on multidisciplinary interventions in FND.
Highlights
Functional neurological disorders (FND) have seen their nomenclature and understanding of mechanisms evolve across history
FND unit consists of five neurologists within the clinic for psychosomatic medicine, which is run by an interdisciplinary team of internists, anesthetists and psychiatrists offering in- and outpatient treatment to other pathologies such as chronic pain, eating disorders, somatic symptoms disorders, etc
Neurosci. 2022, 6, 2 cases, out-patient treatment is organized at our FND Unit, especially for patients living in the direct vicinity or with complex semiology; in approximately 70% of the patients, interdisciplinary treatment is organized externally
Summary
Functional neurological disorders (FND) have seen their nomenclature and understanding of mechanisms evolve across history. FND represent a common disorder, diagnosed in about one-third of general neurology out-patients [3] They are more common in women than men and have a peak incidence between the ages of 35 and 50 [4], even though presentation throughout the lifespan is possible. In 2016, a new clinical care setting was created [13] within the neurology department of Bern University hospital, Switzerland, with a merging of the Psychosomatic Unit, which has long expertise in care of patients with chronic pain, chronic fatigue, and other Somatic Symptom disorders. This article reports the current treatment path offered in this new setting, in light of recent advances in clinical knowledge in the field. It is presented in the form of a narrative review
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