Clinician-rated outcomes of patients with functional neurological disorders treated in an outpatient clinic 2023 LaFrance Jr. et al

Andy

Andy

Retired committee member
Highlights
  • Limited treatment options exist for patients with functional neurological disorders.
  • Psychotherapeutic treatments show encouraging results for FND in research settings.
  • A limited number of published studies explore motor and seizure FND outcomes in the natural outpatient clinic setting.
  • This study reveals improved clinician-rated patient clinical outcomes in motor FND and in FND seizures using manualized therapy.
  • Neuro-behavioral therapy generalizes from research to outpatient clinic setting.
Abstract

Background
Patients with functional neurological (conversion) disorder (FND) have historically been difficult to treat. Outcomes have been studied in research trials, documenting improvements; however, limited information is available from a community-treated FND cohort.

Objectives
We aimed to examine clinical outcomes in outpatients with FND treated with the Neuro-Behavioral Therapy (NBT) approach. These uncontrolled setting treatment data could complement more structured clinical studies results.

Methods
We conducted a retrospective chart review of consecutive patients diagnosed with FND, ages 17 to 75, who were treated with the NBT workbook at the Rhode Island Hospital Behavioral Health clinic between 2014 and 2022. NBT consisted of 45-minute, individual, outpatient sessions, in clinic or via telehealth with one clinician. Global Assessment of Functioning (GAF), and Clinical Global Impression (CGI) –Severity, and –Improvement were scored for every appointment.

Results
Baseline characteristics are available for 107 patients. Mean age at FND symptom onset was 37 years. Patients had a mix of FND semiologies, which included Psychogenic Nonepileptic Seizures (71%), Functional Movement Disorder (24.3%), Functional Sensory Disorder (14%), Functional Weakness (6.5%), and Functional Speech Disorder (5.6%). Clinical evaluation scores revealed improvements over time.

Conclusions
We describe a well-characterized sample of patients with various and mixed FND semiologies, who received manualized therapy, NBT, in an outpatient clinic. Patients had similar psychosocial profiles to those in clinical studies and displayed improvement in clinical measures. These results demonstrate the practicability of NBT for motor FND semiologies and for PNES, in a “real-world” outpatient practice, extending care beyond structured clinical trials.

Paywall, https://www.seizure-journal.com/article/S1059-1311(23)00065-1/fulltext
 
Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI) both use subjective ratings by the clinician of the patient's status.

So the clinicians are self-rating the legitimacy and efficacy of their own subjective interpretation?
 
They present this as something about outcomes but they pretty much end up trying to sell "NBT". What does it even have to do with outcomes? And why would clinician outcomes be any relevant when they don't even know enough to do that?

Anyway, I tried looking for what NBT is and it seems they just mean CBT and I guess this is just classic rebranding, like "a 3 day intervention". Zero hits other than Nature-based therapy.

They're really just describing what they're doing and how much they think it's great. This isn't even research. None of this junk has anything to do with scientific research. Or medicine. Or even with patients. They may as well be working with dolls for all that any of this matters.
 
Sean said:
Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI) both use subjective ratings by the clinician of the patient's status.

So the clinicians are self-rating the legitimacy and efficacy of their own subjective interpretation?
Click to expand...

It is worse than that I think:
Andy said:
We conducted a retrospective chart review of consecutive patients diagnosed with FND, ages 17 to 75, who were treated with the NBT workbook at the Rhode Island Hospital Behavioral Health clinic between 2014 and 2022. NBT consisted of 45-minute, individual, outpatient sessions, in clinic or via telehealth with one clinician. Global Assessment of Functioning (GAF), and Clinical Global Impression (CGI) –Severity, and –Improvement were scored for every appointment.
Click to expand...

For one there would be obviously people they could have done proper long term follow-up on who would have finished their workbook several years back so they could see how much was biased by questions. And probably it would be somewhat akin to being able to use blinding as they might well have had new staff in that space of time (no excuses - moderation techniques are possible for everything so that is perfectly good) so could easily have used controls and blind assessments.

Indeed so many opportunities for things other than the seizures for e.g. video recording - maybe they did that and there were independents looking at these years apart etc. ?

And as only the asbtract is available there is no detail about whether the numbers who attended the clinic, and even those who completed the workbook were all accounted for in the data, no info about drop-out rates

And as a 'real-world scenario' what pressures would there be for progress to be shown re: funding etc? both for patient and clinic - I assume they were measured for good reasons so it would be interesting to know more context about how all that works.

Plus I wonder whether the 'workbook' was 'goal-oriented' as they tend to be. Which isn't quite as real-world as measuring seizures, which I'm unsure how they did?
 
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