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Watson M, Kreuzman J, Zeribi K, Iskander JM, Hopper A, Simon L, Chesley G, Fobian A. The Current State of Pediatric Functional Neurological Disorder Treatment in the United States. Pediatr Neurol 2024; 158:144-155. [PMID: 39059300 DOI: 10.1016/j.pediatrneurol.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/15/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Pediatric functional neurological disorders (FNDs) are common but grossly under-researched. This survey study aims to define the current landscape of pediatric FND treatment in the United States, identifying treatment programs, care team composition, treatment approaches, and aftercare management. METHODS The Functional Neurological Disorder Society (FNDS) Pediatric Special Interest Group (SIG), a diverse set of clinician and caregiver stakeholders, collected information on available treatment programs in the United States via survey. Current programs were identified through the FNDS Pediatric SIG and FND Hope's provider registry. RESULTS Thirty-nine care team members from 24 health care centers yielded 31 unique FND treatment settings. Centers existed in 16 states, concentrated in the Midwest and Southern regions. Outpatient settings (62%) were more prevalent than inpatient. A psychologist (PhD/PsyD) was the most common clinician (52%) with dedicated time to treat FNDs. Most settings accepted ages six to 21 (55%) and treated all FND symptoms (77%). A spectrum of treatment approaches was endorsed with the most common being cognitive behavioral therapy (77%) and personalized approaches (58%). A biopsychosocial approach was evident, with most settings reporting active involvement with school (97%) and caregivers (94%). Most settings (74%) encouraged treatment re-engagement when needed with no strict time limits. All respondents provided aftercare recommendations or referrals. CONCLUSIONS Pediatric FND treatment is available across the United States, but there is high variability in care team membership, treatment approach, and aftercare management. Future research is necessary to develop effective and sustainable treatment to improve access for this population.
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Affiliation(s)
- Meagan Watson
- Department of Neurology, University of Colorado, Aurora, Colorado.
| | - Jason Kreuzman
- St Louis Children's Hospital, Allied Health/Therapy Services, St Louis, Missouri
| | - Karen Zeribi
- Shift-Results, Health Systems Improvement Consulting, Seattle, Washington
| | - Jeannette M Iskander
- Department of NeuroBehavioral Health, NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, Ohio
| | | | - Laura Simon
- Department of Pediatric Rehabilitation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gayle Chesley
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aaron Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama
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Hausteiner-Wiehle C, Schmidt R. [Transdisciplinary treatment of functional movement disorders: integration instead of dissociation]. DER NERVENARZT 2024; 95:532-538. [PMID: 38315181 DOI: 10.1007/s00115-023-01596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 02/07/2024]
Abstract
Successful treatment of patients with functional motor disorders is integrative in several ways: the primary treatment goal is the (re)integration of sensorimotor, cognitive and social functioning. The prerequisites for this are an integrated biopsychosocial model of everyone involved as well as close transdisciplinary cooperation. Instead of a simple addition of treatment components, all care providers and patients act in concert.
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Affiliation(s)
- Constanze Hausteiner-Wiehle
- Psychosomatischer Konsil- und Liaisondienst der Abteilung für Neurologie, Klinische Neurophysiologie und Stroke Unit, BG Unfallklinik Murnau, Prof. Küntscher-Str. 8, 82418, Murnau, Deutschland.
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie der TU München, Klinikum rechts der Isar, München, Deutschland.
- Arbeitsgemeinschaft Funktionelle Neurologische Störungen e. V., .
| | - Roger Schmidt
- Klinik für Psychosomatik und Konsiliarpsychiatrie, Kantonsspital St. Gallen, St. Gallen, Schweiz
- Lurija Institut für Rehabilitationswissenschaften und Gesundheitsforschung, Kliniken Schmieder, Allensbach, Deutschland
- Arbeitsgemeinschaft Funktionelle Neurologische Störungen e. V
- Fachbereich Psychologie, Universität Konstanz, Konstanz, Deutschland
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Finkelstein SA, Carson A, Edwards MJ, Kozlowska K, Lidstone SC, Perez DL, Polich G, Stone J, Aybek S. Setting up Functional Neurological Disorder Treatment Services: Questions and Answers. Neurol Clin 2023; 41:729-743. [PMID: 37775201 DOI: 10.1016/j.ncl.2023.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Functional neurologic disorder (FND) is commonly encountered across outpatient and inpatient medical settings. Given the potential for a high burden of disability in some patients and mounting evidence for the efficacy of FND-specific multidisciplinary treatment services, expanding clinical services for this population is a necessity. In this perspective article, we discuss considerations for creating FND services, including the types of services that exist, how to start, how to identify appropriate referrals, and how to develop and monitor individualized treatment plans. In addition, we discuss how this effort can be done sustainably - balancing patient needs with limited healthcare resources.
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Affiliation(s)
- Sara A Finkelstein
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
| | - Alan Carson
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, 50 Little France Cres, Edinburgh EH16 4SA, UK
| | - Mark J Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kasia Kozlowska
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead Institute for Medical Research, Psychological Medicine, The Children's Hospital at Westmead, Cn Hawkesbury Road, Hainsworth Street, Westmead, NSW 2145, Australia
| | - Sarah C Lidstone
- Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Centre, Room 3-131, 550 University Avenue, Toronto ON M5G 2A2, Canada
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ginger Polich
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, MA 02129, USA
| | - Jon Stone
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, 50 Little France Cres, Edinburgh EH16 4SA, UK
| | - Selma Aybek
- Faculté des Sciences et de Médecine, Université de Fribourg, Bureau 2.106d, Chemin du Musée 5, 1700 Fribourg, Suisse
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Gandolfi M, Sandri A, Geroin C, Bombieri F, Riello M, Menaspà Z, Bonetto C, Smania N, Tinazzi M. Improvement in motor symptoms, physical fatigue, and self-rated change perception in functional motor disorders: a prospective cohort study of a 12-week telemedicine program. J Neurol 2022; 269:5940-5953. [PMID: 35809125 PMCID: PMC9552134 DOI: 10.1007/s00415-022-11230-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Functional motor disorders (FMDs) are highly disabling conditions associated with long-term disability, poor quality of life, and economic burden on health and social care. While multidisciplinary 5-days rehabilitation programs have been shown to reduce motor and non-motor symptoms, long-term management and monitoring in FMDs remain an unmet need. AIM To compare a 12-weeks telemedicine program against a 12-weeks self-management program after a 5-days rehabilitation program for improving motor, non-motor symptoms, quality of life, and perception of change in patients with FMDs. METHODS The study population was 64 consecutive patients with a definite diagnosis of FMDs who underwent a 5-days in-person rehabilitation program followed by either a self-management (the first 32 patients) or a telemedicine program (the latter 32 patients). Validated measures of motor and non-motor symptoms such as fatigue and pain, quality of life, perception of change, gait, and postural control were recorded before (T0), after completion of rehabilitation (T1), and then again at 3 months (T2). RESULTS Improvement at 3-month follow-up assessment of motor symptoms (p < 0.001), physical fatigue (p = 0.028), and self-rated change perception (p = 0.043) was greater in the telemedicine group. No different between-groups effect was found on other dimensions of fatigue, pain, physical and mental health, and gait and postural control. CONCLUSIONS Long-term management and expert monitoring of patients with FMDs via telemedicine may enhance long-term outcomes in motor symptoms and physical fatigue, with a positive long-term impact on self-rated health perception of change.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy.
| | - Angela Sandri
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Christian Geroin
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Federica Bombieri
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Marianna Riello
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy.
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