Functional neurological disorders Flashcards
(29 cards)
objectives of personalised mx for fnd
understand all dx present and their interactions
understand the person and their system
use the information to provide a tailored diagnostic explanation to the person and their family
evidence based tailored mx
What is the Objective of Non-Personalised Management?
a transaction of exchanging symptoms for a medical phrase
clinicians should make sure to proactively ask about…
pain
fatigue
cognitive sx
bladder
sleep
dissociation
normality/ variability
emotional sx (last)
anxiety and panic
risk
multidisciplinary education sessions for fnd (cope et al 2021)
single education session
self-report of understanding, acceptance, treatability belief and hopefulness of dx and recovering at the beginning and end of session
significant increase in all variables
Guided self-help for functional (psychogenic) symptoms (Sharpe et al 2011)
CBT guided self help + usual care
GSH comprised a self-help manual and 4 half-hour guidance sessions
self rated
greater improvement for gsh group
physio4fmd
9 sessions over 3 weeks plus 3 month follow up
- ax
- education
- movement retraining
- acknowledge/ address pain and fatigue
- develop a self mx
what are the movement retraining strategies in physio4fmd
redirect attention to elicit automatic movement
physio4fmd outcomes at 12 months
physical functioning SF36
physio4fmd secondary outcomes at 6 and 12 months
clinical global impression scale of improvement
SF36
functional mobility scale
HADS
fatigue scale
confidence in dx
revised illness perception questionnaire
hospital admission and appointments
physio4fmd tx
specialist phsyio vs tx
high satisfaction in both groups 97% vs 65%
Multicenter pilot treatment trial for psychogenic nonepileptic seizures (lafrance et al 2014)
Medication (flexible-dose sertraline hydrochloride) only, cognitive behavioral therapy informed psychotherapy (CBT-ip) only, CBT-ip with medication (sertraline), or treatment as usual.
Seizure frequency was the primary outcome
The psychotherapy (CBT-ip) arm showed a 51.4% seizure reduction (P = .01)
significant improvement from baseline in secondary measures
The combined arm (CBT-ip with sertraline) showed 59.3% seizure reduction (P = .008)
The sertraline-only arm did not show a reduction in seizures (P = .08).
The treatment as usual group showed no significant seizure reduction or improvement in secondary outcome measures (P = .19).
CODES trial (goldstein 2020)
We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency.
The primary outcome was monthly dissociative seizure frequency
At 12 months, no significant difference in monthly dissociative seizure frequency was identified between the groups
However, improvements were observed in a number of clinically relevant secondary outcomes following CBT plus standardised medical care vs standard care only
what was standard care in the CODES trial
information about the seizures dx by an epileptologist or neurologist
neurology trial specific information booklet about dissociative seizures
psychotherapy for fnd (gutkin et al. 2021, systematic review)
single symptom-based subtype
effect sizes with medium sized benefit for physical symptoms, mental health, well-being, function and resource use for both CBT and PDT
lack of high-quality controlled trials of PDT is a significant limitation
lack of long-term follow-up data in the majority of identified CBT trials
MODIFI - EMDR for FND (cope 2023)
EMDR (plus standard neuropsychiatric care; NPC) and standard NPC
comparisons at baseline (T0), 3 months (T1), 6 months (T2) and 9 months (T3)
what are the eight phases of emdr
I-II: pt hx, ax of suitability and preparation
III: ax of target image, identify negative and positive cognitions, rate subjective distress
IV: desensitisation phase with eye movement
V: installation of positive cognition
VI: target remaining distress
VII: end session
VIII: ax and determine need for further sessions
what does emdr stand for
eye movement desensitisation and reprocessing therapy
neuromodulation for fnd
repetitive transcranial magnetic stimulation (rTMS)
intermittent theta-burst stimulation (iTBS)
transcranial direct current stimulation (tDCS)
transcutaneous electrical nerve stimulation (TENS)
potential targets: motor cortex, temporoparietal junction
dorsolateral prefrontal cortex
rTMS for functional neurological paresis
active 15 Hz rTMS over the contralateral motor cortex (hand area) vs rTMS + placebo
Primary outcome measure was change in muscle strength as measured by dynamometry
rTMS + placebo - active rTMS induced a significantly larger median increase in objectively measured muscle strength vs placebo TMS
TMS on functional movement disorders cortical modulation vs behavioural
cortex contralateral to the symptoms or over the spinal roots homolateral
RMS + TMS vs TMS + RMS
assessed the severity of movement disorders before and after each stimulation session
The magnetic stimulation sessions led to a significant improvement in 66%
no difference between TMS and RMS
right TPJ TMS as a therapeutic target for PNES
video-EEG documented PNES without comorbid epileptic seizures were recruited
decrease in weekly seizure rates post vs. pre-treatment, which was sustained at 3-month follow-up
therapeutic sedation for functional neurological sx
propofol in severe fnd can be a useful adjunct for patients
psychedelics for FND
increased default mode network connectivity is reduced following a dose of psilocybin
