Functional neurologic disorders.

Area of Science:

• Neurology
• Neuroscience
• Psychiatry

Background:

• Functional neurologic disorders (FNDs) are common in neurological practice, often presenting complex diagnostic challenges.
• Historically, FNDs have been associated with psychological factors, leading to varied diagnostic approaches.
• This review focuses on a practical, evidence-based approach to FND assessment and treatment.

Observation:

• Modern classification emphasizes positive diagnosis of FNDs using objective physical signs, moving away from solely psychological criteria.
• Research into the mechanisms of FNDs is yielding novel clinical and neurobiological insights.
• Emerging evidence supports specific therapeutic interventions for different FND subtypes.

Findings:

• Physical therapy demonstrates efficacy in treating functional movement disorders.
• Psychotherapy shows promise in managing dissociative (nonepileptic) attacks.
• A positive diagnostic approach based on clinical signs is crucial for accurate FND assessment.

Implications:

• The diagnosis and management of FNDs are entering an evidence-based era.
• Neurologists should actively engage in educating and treating patients with FNDs.
• Multidisciplinary collaboration with psychiatry, psychology, and physical therapy is essential for optimal FND care.