Schneider Thibault, Leemann Beatrice, Nicastro Nicolas, Schnider Armin
Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
J Clin Neurol. 2024 Sep;20(5):493-500. doi: 10.3988/jcn.2023.0246.
Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. We performed a single-center retrospective study aimed at determining the long-term outcome of FND patients receiving inpatient rehabilitation and the predictors of a good outcome.
A multidisciplinary graded exercise program was provided with one or two daily physiotherapy and occupational therapy sessions on 5 days each week, as well as weekly psychological support. Outcome was assessed using the motor part of the Functional Independence Measure scale (FIM; maximum score of 91) at admission, discharge, and follow-up, with the last assessment performed by phone interview.
The 30 included patients were aged 43.6±14.7 years (mean±standard deviation), comprised 70% females, and received a mean of 4 weeks of rehabilitation. The admission FIM score (80.2±8.3) was significantly lower than the discharge FIM score (86.9±4.6; <0.001, Wilcoxon signed-rank test). No notable difference was observed between discharge and follow-up FIM scores (85.5±8.5, =0.54). The mean follow-up of the 36-month FIM scores at discharge and follow-up was dichotomized as a good outcome in cases where all items were scored ≥6 (functional independence). Binomial logistic regression showed that absence of a comorbid psychiatric disorder (=0.039, odds ratio=10.7) was a predictive factor for a good outcome at follow-up. Other variables (e.g., sex and age) were not significant predictors of clinical outcome (all ≥0.058).
These results suggest inpatient intensive rehabilitation for motor FND is effective and produces favorable long-term results. Further studies with larger groups are warranted so that the management protocols can be standardized.
功能性神经障碍（FND）被定义为存在与神经系统疾病不符的神经症状。我们进行了一项单中心回顾性研究，旨在确定接受住院康复治疗的FND患者的长期预后以及良好预后的预测因素。
提供多学科分级运动计划，每周5天，每天进行一或两次物理治疗和职业治疗，以及每周一次心理支持。在入院、出院和随访时使用功能独立性测量量表（FIM）的运动部分进行评估（最高分91分），最后一次评估通过电话访谈进行。
纳入的30例患者年龄为43.6±14.7岁（均值±标准差），女性占70%，平均接受了4周的康复治疗。入院时FIM评分（80.2±8.3）显著低于出院时FIM评分（86.9±4.6；<0.001，Wilcoxon符号秩检验）。出院和随访时FIM评分之间未观察到显著差异（85.5±8.5，P = 0.54）。将出院和随访时36个月FIM评分的均值进行二分法划分，若所有项目得分≥6（功能独立）则为良好预后。二项逻辑回归显示，无共病精神障碍（P = 0.039，比值比 = 10.7）是随访时良好预后的预测因素。其他变量（如性别和年龄）不是临床结局的显著预测因素（均≥0.058）。
这些结果表明，运动性FND的住院强化康复是有效的，并能产生良好的长期效果。有必要进行更大规模群体的进一步研究，以便规范管理方案。
