Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
Curr Treat Options Neurol. 2014 Apr;16(4):286. doi: 10.1007/s11940-014-0286-5.
For the treatment of functional motor disorder, we recommend a three-stage approach. Firstly, patients must be assessed and given an unambiguous diagnosis, with an explanation that helps them understand that they have a genuine disorder, with the potential for reversibility. A key ingredient is allowing the patients to describe all of their symptoms as well as their ideas about what may be wrong. The patient should clearly understand that the positive diagnosis is based on the presence of typical signs (e.g., Hoover's sign for paralysis, entrainment test for tremor) that, in and of themselves, indicate the potential for reversibility. We suggest an approach that avoids the assumption that psychological stressors in the patient's life are causing the symptoms. The symptoms themselves are often the main stressor. Insisting that there must be others often leads to a frustrated doctor and an angry patient. Rather, at this initial stage, we encourage exploration of mechanisms - e.g., triggering of symptoms by pain, injury, or dissociation - and a discussion of how symptoms manifest as "abnormal motor programs" in the nervous system.Secondly, further time spent exploring the diagnosis, treating comorbidity, and, in the context of a multidisciplinary team, experimenting with altered movements and behaviors may benefit some patients, without the need for more complex intervention.Thirdly, some patients do require more complex treatment, often with a combination of physical rehabilitation and psychological treatments. Hypnosis, sedation, and transcranial magnetic stimulation may have a role in select patients.Finally, although they have confidence in the diagnosis, many patients do not respond to treatment. Ultimately, however, patients with functional motor disorder may have much greater potential for recovery than health professionals often consider.
对于功能性运动障碍的治疗，我们建议采用三阶段方法。首先，必须对患者进行评估并做出明确诊断，并向他们解释有助于其理解的内容，即他们确实患有一种潜在可逆转的疾病。其中一个关键要素是允许患者描述他们所有的症状以及他们对可能出现的问题的想法。患者应清楚地了解，阳性诊断是基于存在典型体征（例如，瘫痪的 Hoover 征，震颤的擒纵试验），这些体征本身表明具有潜在的可逆转性。我们建议采用一种避免假设患者生活中的心理压力源导致症状的方法。症状本身往往是主要的压力源。坚持认为必须有其他原因通常会导致医生感到沮丧和患者感到愤怒。相反，在初始阶段，我们鼓励探索机制，例如，疼痛、损伤或分离触发症状，以及讨论症状如何在神经系统中表现为“异常运动程序”。其次，进一步花时间探讨诊断、治疗合并症，并在多学科团队的背景下，尝试改变运动和行为，可能会使一些患者受益，而无需更复杂的干预。第三，一些患者确实需要更复杂的治疗，通常是物理康复和心理治疗的结合。在某些患者中，催眠、镇静和经颅磁刺激可能有作用。最后，尽管患者对诊断有信心，但许多患者对治疗没有反应。然而，患有功能性运动障碍的患者最终可能比健康专业人员通常认为的具有更大的康复潜力。
