Treatment outcomes in the inpatient management of severe functional neurological disorder: a retrospective cohort study 2024 Saunders et al

Abstract

Background
Functional neurological disorder (FND) is a heterogeneous condition; severe forms can be disabling. Multidisciplinary treatment and rehabilitation are recommended for severe FND, but there remains a lack of evidence for its efficacy and lack of understanding of the predictors and components of recovery.

Methods
We report clinical outcome data for an inpatient cohort with severe FND. Clinical Global Impression Improvement with treatment is the primary outcome measure. Admission and discharge measures (Euroqol quality of life measures, Beck Depression Inventory, Spielberger Trait Anxiety Inventory, Cambridge Depersonalisation Scale, Illness Perception Questionnaire (Revised) and Functional Mobility Scale) are reported as secondary outcomes.

Results
We describe an FND cohort (n=52) with chronic illness (mean symptom duration 9.7 years). At admission, there were clinically relevant levels of depression, anxiety and depersonalisation derealisation. At the time of discharge, most (43/52) patients’ global condition had improved. Measures of mobility, depression and quality of life also significantly improved while at discharge, symptoms were experienced as more understandable and less distressing than at admission. An admission measure of patient confidence in treatment was predictive of eventual clinical outcome.

Conclusions
The most frequent outcome of inpatient rehabilitation is global improvement, even when symptoms are chronic and severe, reflected in measurable changes in both physical and psychological functioning. Significant levels of depersonalisation derealisation seen in this patient group suggest that routine enquiry into such experiences could help personalise FND treatment approaches. Patient confidence in treatment is key in determining clinical outcomes.

Open access, https://neurologyopen.bmj.com/content/6/2/e000675

 

"In terms of their primary functional symptom, reflecting the degree of severity in our patient group, the majority of patients (n=31) had mixed symptoms (generally a combination of motor and sensory symptoms with non-epileptic seizures, plus cognitive symptoms in some cases) such that it was impossible to identify a primary symptom. Where a primary symptom could be identified these were seizures (n=9), functional motor symptoms (n=7), cognitive symptoms (n=3) and extreme fatigue (n=2). Sensory disturbance was common alongside motor symptoms, but no patients were admitted primarily for treatment of sensory symptoms. Systemic symptoms were reported commonly: 94% of patients reported fatigue, 96% pain, 84% dizziness, 78% bowel disturbance and 71% breathlessness."