LaFaver Kathrin, LaFrance William Curt, Price Michele E, Rosen Phyllis B, Rapaport Mark
Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.
CNS Spectr. 2020 Dec 7:1-7. doi: 10.1017/S1092852920002138.
Functional neurological disorder (FND) encompasses a complex and heterogeneous group of neuropsychiatric syndromes commonly encountered in clinical practice. Patients with FND may present with a myriad of neurological symptoms and frequently have comorbid medical, neurological, and psychiatric disorders. Over the past decade, important advances have been made in understanding the pathophysiology of FND within a biopsychosocial framework. Many challenges remain in addressing the stigma associated with this diagnosis, refining diagnostic criteria, and providing access to evidence-based treatments. This paper outlines FND treatment approaches, emphasizing the importance of respectful communication and comprehensive explanation of the diagnosis to patients, as critical first step to enhance engagement, adherence, self-agency, and treatment outcomes. We then focus on a brief review of evidence-based treatments for psychogenic non-epileptic seizures and functional movement disorder, a guide for designing future treatment trials for FND, and a proposal for a treatment research agenda, in order to aid in advancing the field to develop and implement treatments for patients with FND.
功能性神经障碍（FND）涵盖了临床实践中常见的一组复杂且异质性的神经精神综合征。FND患者可能会出现无数种神经症状，并且常常合并有内科、神经科和精神科疾病。在过去十年中，在生物心理社会框架内理解FND的病理生理学方面取得了重要进展。在应对与该诊断相关的污名化、完善诊断标准以及提供循证治疗方面，仍存在许多挑战。本文概述了FND的治疗方法，强调了尊重地与患者沟通并全面解释诊断的重要性，这是增强患者参与度、依从性、自我能动性和治疗效果的关键第一步。然后，我们重点简要回顾了针对精神性非癫痫性发作和功能性运动障碍的循证治疗方法，设计未来FND治疗试验的指南以及治疗研究议程的提案，以推动该领域发展并为FND患者开发和实施治疗方法。
