Toward a Precision Medicine Approach to the Outpatient Assessment and Treatment of Functional Neurological Disorder

David L Perez; Sara Finkelstein; Caitlin Adams; Aneeta Saxena

doi:10.1016/j.ncl.2023.02.006

Toward a Precision Medicine Approach to the Outpatient Assessment and Treatment of Functional Neurological Disorder

Neurol Clin. 2023 Nov;41(4):681-693. doi: 10.1016/j.ncl.2023.02.006. Epub 2023 Mar 15.

Authors

David L Perez¹, Sara Finkelstein², Caitlin Adams³, Aneeta Saxena²

Affiliations

¹ Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA. Electronic address: dlperez@nmr.mgh.harvard.edu.
² Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.

PMID: 37775198
DOI: 10.1016/j.ncl.2023.02.006

Abstract

Functional neurological disorder (FND) is a neuropsychiatric condition. In this field, prospective psychotherapy trials and consensus recommendations for physiotherapy, occupational therapy, and speech language therapy have been published. However, significant clinical complexities remain. "Rule in" signs - while critical for making a positive diagnosis - do not equate to a personalized treatment plan in many instances. Here, we propose that the neuropsychiatric assessment and real-time development of a work-in-progress biopsychosocial clinical formulation aids the development of a patient-centered outpatient treatment plan. This precision medicine approach is based on the literature, expert opinions and our clinical experience working in an interdisciplinary FND service.

Keywords: Biopsychosocial; Functional cognitive disorder; Functional movement disorder; Functional neurological disorder; Functional seizures; Neuropsychiatry; Persistent postural perceptual dizziness; Treatment.

Publication types

Review