Can neurologists manage patients with Functional Neurological Disorders?

Movement disorders

By Michael Woodhead

9 Jul 2019

Neurologists are confident they can manage patients with Functional Neurological Disorders (FND) but the reality is that many are unable or unwilling to help ‘difficult’ patients who don’t have an ‘organic’ cause of symptoms, the authors of a new Australian study say.

The first national survey of health professionals who manage patients with conditions such as functional limb weakness, numbness, shaking or blackouts found that a sizeable minority – around 20% – did not believe the symptoms were ‘real’ and they had negative attitudes towards patients who they suspected may be malingering.

The survey – which included 79 neurologists as well as psychiatrists, GPs, physiotherapists and nurses – also found that 44% of health professionals reported patients as being demanding and difficult to deal with.

Among health professionals who had a positive attitude towards helping patients with FND there was a lack of awareness and confidence in the management of the condition and frustration about the lack of support or referral options from other specialties.

Led by Dr Alex Lehn, a neurologist who runs an FND Clinic at Brisbane’s Mater Centre for Neurosciences, Brisbane, the study showed that neurologists reported the greatest knowledge and training with FND, and yet they also expressed less clinical interest and more negative attitudes than other health professionals.

Since neurologists reported that they generally felt confident diagnosing (85%) and discussing (86%) FNDs, the negative attitudes to treating patients might arise from practical difficulties in helping  patients, the study authors suggested.

‘‘If there was enough time for the consultation, then management of these patients would be easier, as it takes time to be thorough, time to discuss the condition adequately to gain trust, and perhaps over a few consultations, before the patients trust you enough to have this diagnosis made,” one neurologist respondent commented

Neurologists had the highest  confidence levels of all health professionals in the communication of FND, “which is not our anecdotal experience in clinical practice at a specialist FND clinic in Australia,” the study authors said.

This could be due to potential responder bias, but also because “some neurologists might find it hard to admit that they sometimes struggle with these patients,” according to Dr Lehn.

He emphasised that there was now an increasing body of evidence for effective treatments of FNDs including physical rehabilitation for functional movement disorders and  psychological therapy in the form of CBT for patients with non-epileptic seizures.

“Even just one good explanation by the treating doctor can result in improved outcomes,” he said.

It was notable that confidence in discussing and managing FND with patients did not correlate with years in practice but with exposure to patients, he added.

Dr Lehn and colleagues said the survey showed there was a clear need for greater awareness and education for FND among health professionals – including neurologists – in Australia.

They highlighted that the most recent ‘Handbook of Clinical Neurology’ dedicated a whole volume to Functional Neurological Disorders, offering an in-depth overview on all aspects of this group of disorders. The authors also pointed to online resources such as the sites site and which provide both health professionals and patients a good overview of symptoms and how to manage them.

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