The Consensus Standard
Management of FND has been standardized through several landmark consensus papers. These guidelines emphasize that FND is a neurological disorder that requires a specific, multidisciplinary approach.
Core Recommendations
- Early Diagnosis: Diagnosis should be made promptly based on positive physical signs, avoiding unnecessary and harmful 'exclusionary' testing.
- Explicit Communication: The diagnosis must be communicated clearly, using the word 'Functional' and explaining the software vs. hardware model.
- MDT Involvement: Patients should have access to a team including neurology, physiotherapy, and often psychiatry or psychology.
Physiotherapy Guidelines
The 2015 "Physiotherapy for functional motor disorders: a consensus recommendation" provides the framework for physical rehabilitation. Key takeaways include:
- External Attentional Focus: Guiding patients to focus on the effect of a movement rather than the bodily mechanics.
- Diverting Attention: Using distraction during physical tasks to allow automatic movements to emerge.
- Normalization: Communicating that the limbs are healthy and capable of normal movement.
The Role of Psychiatry
Seizure (PNES) Guidelines
Guidelines for PNES emphasize the removal of anti-epileptic drugs (after careful tapering) and the initiation of specialized psycho-education or CBT to address the underlying dissociative mechanism.
Outcome Measurement
Clinicians should measure outcomes based on Quality of Life and Function, rather than just symptom frequency. Improvement in vocational and social participation is the gold standard for successful FND management.