Modèles de soins validés pour les patients souffrant de troubles neurologiques fonctionnels [Validated care programs for patients with functional neurological disorders]
Details
Serval ID
serval:BIB_9EBF14784B11
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Modèles de soins validés pour les patients souffrant de troubles neurologiques fonctionnels [Validated care programs for patients with functional neurological disorders]
Journal
L'Encephale
ISSN
0013-7006 (Print)
ISSN-L
0013-7006
Publication state
Published
Issued date
08/2023
Peer-reviewed
Oui
Volume
49
Number
4S
Pages
S33-S41
Language
french
Notes
Publication types: Review ; English Abstract ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. Diagnostic delay may lead to no treatment, inappropriate treatment or even iatrogenic symptoms. Yet, several treatments significantly reduce physical symptoms and improve functioning in FND patients even though not all patients respond to the currently available treatments. This review aims to describe the range of evidence-based rehabilitative and/or psychological therapeutic approaches available for FND patients. The most effective treatments are multidisciplinary and coordinated; using an outpatient or inpatient setting. Building a network of FND-trained healthcare professionals around the patient is an essential aspect of optimal patient management. Indeed, a supportive environment coupled with a collaborative therapeutic relationship improves understanding of FND and appears to help patients engage in appropriate treatments. Patients need to be invested in their own care and have to understand that recovery may depend on their commitment. The conventional treatment combines psychoeducation, physical rehabilitation and psychotherapy (cognitive and behavioral therapy, hypnosis, psychodynamic interpersonal therapy). Early referral of patients to physical therapy is recommended; however, the optimal parameters of treatment, duration and intensity are unknown and seem to vary with the severity and chronicity of symptoms. The goal is to minimize self-awareness by diverting attention or by stimulating automatically generated movements with non-specific and gradual exercises. The use of compensatory technical aids should be avoided as much as possible. Psychotherapeutic management should encourage self-evaluation of cognitive distortions, emotional reactions and maladaptive behaviors while empowering the patient in managing symptoms. Symptom management can use anchoring strategies to fight against dissociation. The aim is to connect to the immediate environment and to enrich one's sensoriality. The psychological interventions should then be adapted to the individual psychopathology, cognitive style and personality functioning of each patient. There is currently no known curative pharmacological treatment for FND. The pharmacological approach rather consists of progressively discontinuing medication that was introduced by default and that could lead to undesirable side effects. Finally, neurostimulation (transcranial magnetic stimulation, transcranial direct current stimulation) can be effective on motor FND.
Keywords
Humans, Transcranial Direct Current Stimulation, Delayed Diagnosis, Conversion Disorder/diagnosis, Conversion Disorder/therapy, Dissociative Disorders, Psychotherapy, Conversion, Conversion hystérie, Crises fonctionnelles dissociatives, Functional dissociative seizure, Functional neurological disorder, Hysteria, Traitement, Treatment, Troubles neurologiques fonctionnels
Pubmed
Web of science
Create date
17/04/2025 11:21
Last modification date
18/04/2025 7:05