Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Inpatient Psychiatry, Department of Psychiatry, Mass General Brigham Salem Hospital, Salem, Massachusetts.
Semin Neurol. 2022 Apr;42(2):204-224. doi: 10.1055/s-0042-1742773. Epub 2022 Feb 21.
There is a growing body of knowledge regarding management of functional neurological disorder (FND). The aim of this article is to guide the clinician through FND clinical management, from delivery of the diagnosis, to creation of a biopsychosocially-informed treatment plan, to troubleshooting common issues that arise throughout longitudinal care. We review the evidence and core principles of both rehabilitative therapies (physical therapy, occupational therapy, and speech and language therapy) and psychological therapies for the treatment of FND, and discuss the benefits of engaging a multidisciplinary and interdisciplinary team. The optimal timing of specific therapeutic interventions is also discussed, emphasizing a patient-centered perspective. Resources for further reading, for both patients and clinicians, are provided throughout. Additional research is needed to further optimize the therapeutic approach to patients with FND, including the need to develop novel treatments for those that do not positively respond to currently available interventions.
目前,有关功能性神经障碍(FND)管理的知识不断增加。本文旨在为临床医生提供 FND 临床管理方面的指导,从诊断的提供,到制定生物心理社会信息治疗计划,再到解决长期护理过程中出现的常见问题。我们回顾了康复治疗(物理治疗、职业治疗和言语及语言治疗)和心理治疗治疗 FND 的证据和核心原则,并讨论了组建多学科和跨学科团队的益处。还讨论了特定治疗干预措施的最佳时机,强调了以患者为中心的观点。为患者和临床医生提供了贯穿全文的进一步阅读资源。需要进一步研究以进一步优化 FND 患者的治疗方法,包括为那些对现有干预措施无反应的患者开发新的治疗方法。