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Published online: 2024-06-25

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Functional neurological disorder: a comparative analysis of experience of Czech, Slovak, and Italian neurologists

Angela Marotta1, Mirta Fiorio1, Ilaria Antonella Di Vico1, Lucia Nováková2, Matej Škorvánek34, Evžen Růžička2, Michele Tinazzi1, Tereza Serranová2

Abstract

Aim of study. We aimed to compare knowledge, opinions, and clinical experiences among Czech, Slovak, and Italian neurologists to identify potential educational gaps and unify understanding.

Clinical rationale for study. Functional neurological disorder (FND) is a disabling condition characterised by motor, sensory, or cognitive symptoms which are incompatible with other neurological disorders. Novel diagnostic and treatment approaches have improved FND management. However, the extent of their adoption, and any differences or similarities across European communities, remain to be established. Material and methods. Members of the Czech and Slovak Neurological Societies were invited via e-mail to participate in a 14- -item web-based survey investigating their approach to FND. This data was compared to results from a previous study involving 492 Italian neurologists.

Results. 232 questionnaires were completed by Czech and Slovak neurologists (CZ-SK). Similarities were found between CZ- -SK and Italian neurologists in their preference for the term ‘FND’ over other psychological-related terms and in explaining symptoms as due to abnormal functioning of the nervous system rather than attributing them to mental illness. However, only fewer than 5% in both groups thought that simulation was highly unlikely. Both groups reported relying on positive signs (e.g. inconsistency, distractibility) according to the current diagnostic criteria, but also a tendency to perform additional tests to exclude other causes. However, some differences were observed: Italian neurologists placed a greater emphasis on psychological factors including litigation. CZ-SK neurologists were more likely to suggest physiotherapy as a treatment option and to provide educational intervention for patients and their relatives.

Conclusions. Overall, our findings suggest that although Czech, Slovak, and Italian neurologists have adopted some new developments in the field of FND, significant gaps still exist in their understanding and common practices regarding conceptualisation, diagnosis, and treatment.

Clinical implications. Our results suggest that promoting knowledge through postgraduate curricula and teaching courses for neurologists is necessary to optimise patient management in various European countries.

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References

  1. Espay AJ, Aybek S, Carson A, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol. 2018; 75(9): 1132–1141.
  2. Carson A, Ludwig L, Welch K. Psychologic theories in functional neurologic disorders. Handb Clin Neurol. 2016; 139: 105–120.
  3. Drane DL, Fani N, Hallett M, et al. A framework for understanding the pathophysiology of functional neurological disorder. CNS Spectr. 2020 [Epub ahead of print]: 1–7.
  4. van Poppelen D, Saifee TA, Schwingenschuh P, et al. Attention to self in psychogenic tremor. Mov Disord. 2011; 26(14): 2575–2576.
  5. Maurer CW, LaFaver K, Ameli R, et al. Impaired self-agency in functional movement disorders: A resting-state fMRI study. Neurology. 2016; 87(6): 564–570.
  6. Spence SA, Crimlisk HL, Cope H, et al. Discrete neurophysiological correlates in prefrontal cortex during hysterical and feigned disorder of movement. Lancet. 2000; 355(9211): 1243–1244.
  7. Voon V, Brezing C, Gallea C, et al. Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder. Mov Disord. 2011; 26(13): 2396–2403.
  8. Voon V, Brezing C, Gallea C, et al. Emotional stimuli and motor conversion disorder. Brain. 2010; 133(Pt 5): 1526–1536.
  9. Aybek S, Nicholson TR, Zelaya F, et al. Neural correlates of recall of life events in conversion disorder. JAMA Psychiatry. 2014; 71(1): 52–60.
  10. Pick S, Goldstein LH, Perez DL, et al. Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. J Neurol Neurosurg Psychiatry. 2019; 90(6): 704–711.
  11. Marotta A, Fiorio M, Riello M, et al. Attentional avoidance of emotions in functional movement disorders. J Psychosom Res. 2020; 133: 110100.
  12. Nahab FB, Kundu P, Maurer C, et al. Impaired sense of agency in functional movement disorders: An fMRI study. PLoS One. 2017; 12(4): e0172502.
  13. Pareés I, Brown H, Nuruki A, et al. Loss of sensory attenuation in patients with functional (psychogenic) movement disorders. Brain. 2014; 137(Pt 11): 2916–2921.
  14. Schrag AE, Mehta AR, Bhatia KP, et al. The functional neuroimaging correlates of psychogenic versus organic dystonia. Brain. 2013; 136(Pt 3): 770–781.
  15. Ding JM, Kanaan RA. Conversion disorder: A systematic review of current terminology. Gen Hosp Psychiatry. 2017; 45: 51–55.
  16. APA. Diagnostic and statistical manual of mental disorders. (5th ed.). 5th Edition ed. Arlington, VA: American Psychiatric Publishing 2013.
  17. Gupta A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol. 2009; 22(4): 430–436.
  18. Hess CW, Espay AJ, Okun MS. Inconsistency and incongruence: the two diagnostic pillars of functional movement disorder. Lancet. 2022; 400(10348): 328.
  19. Demartini B, Batla A, Petrochilos P, et al. Multidisciplinary treatment for functional neurological symptoms: a prospective study. J Neurol. 2014; 261(12): 2370–2377.
  20. Palmer DDG, Gamble M, Higgins M, et al. Outcomes of an Integrated Multidisciplinary Clinic for People with Functional Neurological Disorder. Mov Disord Clin Pract. 2023; 10(6): 967–973.
  21. LaFaver K, Lang AE, Stone J, et al. Opinions and clinical practices related to diagnosing and managing functional (psychogenic) movement disorders: changes in the last decade. Eur J Neurol. 2020; 27(6): 975–984.
  22. Perez DL, Edwards MJ, Nielsen G, et al. Decade of progress in motor functional neurological disorder: continuing the momentum. J Neurol Neurosurg Psychiatry. 2021 [Epub ahead of print].
  23. Kanaan RA, Armstrong D, Wessely SC. Neurologists' understanding and management of conversion disorder. J Neurol Neurosurg Psychiatry. 2011; 82(9): 961–966.
  24. Tinazzi M, Fiorio M, Berardelli A, et al. Opinion, knowledge, and clinical experience with functional neurological disorders among Italian neurologists: results from an online survey. J Neurol. 2022; 269(5): 2549–2559.
  25. de Schipper LJ, Vermeulen M, Eeckhout AM, et al. Diagnosis and management of functional neurological symptoms: The Dutch experience. Clin Neurol Neurosurg. 2014; 122: 106–112.
  26. Edwards MJ, Yogarajah M, Stone J, et al. Why functional neurological disorder is not feigning or malingering. Nat Rev Neurol. 2023; 19(4): 246–256.
  27. Espay AJ, Ries S, Maloney T, et al. Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology. 2019; 93(19): e1787–e1798.
  28. Gelauff J, Stone J, Edwards M, et al. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry. 2014; 85(2): 220–226.
  29. Goldstein LH, Robinson EJ, Mellers JDC, et al. CODES study group. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry. 2020; 7(6): 491–505.
  30. Lin A, Espay AJ. Remote delivery of cognitive behavioral therapy to patients with functional neurological disorders: Promise and challenges. Epilepsy Behav Rep. 2021; 16: 100469.
  31. O'Connell N, Watson G, Grey C, et al. Outpatient CBT for Motor Functional Neurological Disorder and Other Neuropsychiatric Conditions: A Retrospective Case Comparison. J Neuropsychiatry Clin Neurosci. 2020; 32(1): 58–66.
  32. Stone J, Carson A, Hallett M. Chater 44 - Exlanation as treatment for functional neurologic disorders. In: Hallett M, , , editors. Handbook of Clinical Neurology.Stone J, Carson A, Hallett M. ed. 139: Elsevier; 2016: 543–553.
  33. Czarnecki K, Thompson JM, Seime R, et al. Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol. Parkinsonism Relat Disord. 2012; 18(3): 247–251.
  34. Jordbru AA, Smedstad LM, Klungsøyr O, et al. Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up. J Rehabil Med. 2014; 46(2): 181–187.
  35. Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015; 86(10): 1113–1119.
  36. Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res. 2013; 75(2): 93–102.
  37. Saxena A, Godena E, Maggio J, et al. Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective. Neuropsychiatr Dis Treat. 2020; 16: 2119–2134.
  38. Garcia CA, Martín AG, Liétor MM, et al. Functional Neurological Disorder: a multidisciplinary approach. European Psychiatry. 2022; 65(S1): S396–S396.
  39. Marotta A, Fiorio M, Fracasso I, et al. Functional Neurological Disorders as Seen by a Cohort of General Practitioners in Northern Italy: Evidence From an Online Survey. Front Neurol. 2021; 12: 583672.
  40. Marotta A, Lasalvia A, Fiorio M, et al. Psychiatrists' attitudes towards functional neurological disorders: results from a national survey. Front Psychiatry. 2023; 14: 1216756.
  41. Lehn A, Bullock-Saxton J, Newcombe P, et al. Survey of the perceptions of health practitioners regarding Functional Neurological Disorders in Australia. J Clin Neurosci. 2019; 67: 114–123.
  42. Lehn A, Navaratnam D, Broughton M, et al. Functional neurological disorders: effective teaching for health professionals. BMJ Neurol Open. 2020; 2(1): e000065.