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Exploring therapeutic interventions for functional neurological disorders: a comprehensive scoping review
Francesca Sireci1, Federica Ragucci2, Chiara Menozzi3
1Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
Journal of Neurology
|May 22, 2024
Summary
Functional Neurological Disorders (FNDs) present complex challenges in healthcare access and treatment. This review highlights the need for multidisciplinary, stepped-care models to address diverse FND manifestations effectively.
Area of Science:
- Neurology
- Psychiatry
- Rehabilitation Medicine
Background:
- Functional Neurological Disorders (FNDs) involve complex symptom presentation and challenging healthcare navigation.
- Existing care pathways for FNDs can be circular and self-perpetuating, hindering effective treatment.
- Misinterpretations surrounding FND necessitate exploring alternatives beyond purely medical therapies.
Purpose of the Study:
- To conduct a scoping review mapping recent practices and interventions for Functional Neurological Disorders.
- To identify and analyze current care pathways and treatment approaches for FNDs.
- To advocate for integrated care models that move beyond traditional medical therapies.
Main Methods:
- A scoping review methodology was employed to synthesize existing literature.
- Searched for relevant papers published between January 2018 and December 2022.
- Focused on interventions and care pathways documented in US and UK healthcare settings.
Main Results:
- 31 papers were identified, primarily from US and UK healthcare systems.
- Interventions were delivered by multidisciplinary teams or individual psychotherapists.
- Distinct care pathways exist for motor vs. non-motor FNDs, with varied referrals (e.g., physical therapy for motor, mental health for non-epileptic seizures).
- Limited focus on ancillary services like social work or occupational therapy.
- High heterogeneity in assessment tools and treatment outcome measures was observed.
- Neurologists/psychiatrists diagnose, while physiotherapists/psychologists often deliver treatment.
Conclusions:
- Functional Neurological Disorders require tailored, multidisciplinary treatments.
- A stepped care model, progressing from standard to individualized modules, is recommended.
- Addressing the complex etiopathology and comorbidities of FNDs necessitates integrated, holistic approaches.
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