TY - JOUR
T1 - Clinician-rated outcomes of patients with functional neurological disorders treated in an outpatient clinic
AU - LaFrance, W. Curt
AU - Tedesco, Roberta
AU - Baird, Grayson L.
AU - Wincze, Jeff
AU - Tocco, Krista
AU - Anderson, Jordan
N1 - Publisher Copyright:
© 2023 British Epilepsy Association
PY - 2023/4
Y1 - 2023/4
N2 - Background: Patients with functional neurological (conversion) disorder (FND) have historically been difficult to treat. Outcomes have been studied in research trials, documenting improvements; however, limited information is available from a community-treated FND cohort. Objectives: We aimed to examine clinical outcomes in outpatients with FND treated with the Neuro-Behavioral Therapy (NBT) approach. These uncontrolled setting treatment data could complement more structured clinical studies results. Methods: We conducted a retrospective chart review of consecutive patients diagnosed with FND, ages 17 to 75, who were treated with the NBT workbook at the Rhode Island Hospital Behavioral Health clinic between 2014 and 2022. NBT consisted of 45-minute, individual, outpatient sessions, in clinic or via telehealth with one clinician. Global Assessment of Functioning (GAF), and Clinical Global Impression (CGI) –Severity, and –Improvement were scored for every appointment. Results: Baseline characteristics are available for 107 patients. Mean age at FND symptom onset was 37 years. Patients had a mix of FND semiologies, which included Psychogenic Nonepileptic Seizures (71%), Functional Movement Disorder (24.3%), Functional Sensory Disorder (14%), Functional Weakness (6.5%), and Functional Speech Disorder (5.6%). Clinical evaluation scores revealed improvements over time. Conclusions: We describe a well-characterized sample of patients with various and mixed FND semiologies, who received manualized therapy, NBT, in an outpatient clinic. Patients had similar psychosocial profiles to those in clinical studies and displayed improvement in clinical measures. These results demonstrate the practicability of NBT for motor FND semiologies and for PNES, in a “real-world” outpatient practice, extending care beyond structured clinical trials.
AB - Background: Patients with functional neurological (conversion) disorder (FND) have historically been difficult to treat. Outcomes have been studied in research trials, documenting improvements; however, limited information is available from a community-treated FND cohort. Objectives: We aimed to examine clinical outcomes in outpatients with FND treated with the Neuro-Behavioral Therapy (NBT) approach. These uncontrolled setting treatment data could complement more structured clinical studies results. Methods: We conducted a retrospective chart review of consecutive patients diagnosed with FND, ages 17 to 75, who were treated with the NBT workbook at the Rhode Island Hospital Behavioral Health clinic between 2014 and 2022. NBT consisted of 45-minute, individual, outpatient sessions, in clinic or via telehealth with one clinician. Global Assessment of Functioning (GAF), and Clinical Global Impression (CGI) –Severity, and –Improvement were scored for every appointment. Results: Baseline characteristics are available for 107 patients. Mean age at FND symptom onset was 37 years. Patients had a mix of FND semiologies, which included Psychogenic Nonepileptic Seizures (71%), Functional Movement Disorder (24.3%), Functional Sensory Disorder (14%), Functional Weakness (6.5%), and Functional Speech Disorder (5.6%). Clinical evaluation scores revealed improvements over time. Conclusions: We describe a well-characterized sample of patients with various and mixed FND semiologies, who received manualized therapy, NBT, in an outpatient clinic. Patients had similar psychosocial profiles to those in clinical studies and displayed improvement in clinical measures. These results demonstrate the practicability of NBT for motor FND semiologies and for PNES, in a “real-world” outpatient practice, extending care beyond structured clinical trials.
KW - Clinical global impression (CGI)
KW - Functional neurological disorders
KW - Global assessment of function (GAF)
KW - Neuro-behavioral therapy
KW - Psychotherapy
KW - Treatment
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U2 - 10.1016/j.seizure.2023.03.005
DO - 10.1016/j.seizure.2023.03.005
M3 - Article
C2 - 36933399
AN - SCOPUS:85150358514
SN - 1059-1311
VL - 107
SP - 21
EP - 27
JO - Seizure
JF - Seizure
ER -