The Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland (Aybek, Bassetti); the Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and University of Toronto (Lidstone, Lang); the Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London (Nielsen, Edwards); and the Department of Psychiatry, University Health Network and University of Toronto (MacGillivray).
J Neuropsychiatry Clin Neurosci. 2020 Winter;32(1):79-84. doi: 10.1176/appi.neuropsych.19040083. Epub 2019 Oct 7.
A growing interest in functional neurological disorders (FND) has led to the development of specialized clinics. This study aimed to better understand the structure and role of such clinics.
Data were retrospectively collected from clinical records at three national referral centers, two specifically for motor FND and one for FND in general. Data were for 492 consecutive patients referred over a 9- to 15-month period: 100 from the United Kingdom clinic, 302 from the Swiss clinic, and 90 from the Canadian clinic. Data included symptom subtype and duration, comorbid pain and fatigue, disability, and treatment recommendations.
The mean age of the 492 patients was 44 years, and most (73%) were female. Most had a prolonged motor FND (mean symptom duration of 6 years); 35% were not working because of ill health, 26% received disability benefits, and up to 38% required a care giver for personal care. In the Swiss cohort, 39% were given a diagnosis of another somatic symptom disorder rather than an FND diagnosis. Pain was common in the United Kingdom (79%) and Canada (56%), as was fatigue (48% and 47%, respectively). Most patients (61%) were offered physiotherapy; referral to neuropsychiatry or psychology differed across centers (32%-100%).
FND specialty clinics have an important role in ensuring correct diagnosis and appropriate treatment. Most patients with motor FND require specialized neurophysiotherapy. Patients readily accepted an integrated neuropsychiatric approach. Close collaboration between FND clinics and acute neurology facilities might improve early detection of FND and could improve outcomes.
对功能性神经障碍（FND）的日益关注导致了专门诊所的发展。本研究旨在更好地了解这些诊所的结构和作用。
从三个国家转诊中心的临床记录中回顾性收集数据，其中两个专门用于运动 FND，一个用于一般 FND。数据来自于 9 至 15 个月期间连续转诊的 492 名患者：英国诊所 100 名，瑞士诊所 302 名，加拿大诊所 90 名。数据包括症状亚型和持续时间、合并疼痛和疲劳、残疾和治疗建议。
492 名患者的平均年龄为 44 岁，大多数（73%）为女性。大多数患者的运动 FND 持续时间较长（平均症状持续时间为 6 年）；35%因健康不佳而无法工作，26%获得残疾津贴，多达 38%需要护理人员进行个人护理。在瑞士队列中，39%的患者被诊断为另一种躯体症状障碍，而不是 FND 诊断。英国（79%）和加拿大（56%）的疼痛常见，疲劳也很常见（分别为 48%和 47%）。大多数患者（61%）接受物理治疗；神经精神病学或心理学转诊在各中心之间存在差异（32%-100%）。
FND 专科诊所对于确保正确诊断和适当治疗具有重要作用。大多数运动 FND 患者需要专门的神经生理学治疗。患者欣然接受了综合神经精神病学方法。FND 诊所与急性神经病学设施之间的密切合作可能会改善 FND 的早期发现，并改善结果。
