Functional Neurologic Disorder Series - Part 6

In part six of this seven-part series on FND, Dr. Jon Stone and Dr. Gabriela Gilmour discuss the prognosis of functional neurologic disorders. 

Show citation: 

Gelauff J, Stone J. Prognosis of functional neurologic disorders. Handb Clin Neurol. 2016;139:523-541. doi:10.1016/B978-0-12-801772-2.00043-6 

Show transcript: 

Dr. Jon Stone:

This is Jon Stone with the Neurology Minute. Gabriela Gilmour and I are back to continue with part six of our seven-part series on FND. Today we're going to talk about prognosis. What's the outlook for people with FND? It's obviously a question that patients and relatives desperate to know the answer. Gabriela, what do you say to your patients with FND when they say, "What's going to happen to me?

Dr. Gabriela Gilmour:

That's a difficult question because the prognosis is variable and I'll talk in a moment about what we know about prognosis from the literature. But I think when patients ask me what's going to happen, I try to instill hope because we do know that this is a condition that can improve and it can improve, especially when patients have access to rehabilitation programs or psychotherapy or other treatment plans. So I try to emphasize that piece and emphasize hope when I'm talking about that with my patients. But if we sort of take a step back and we look at what is the overall prognosis from what we know in the literature with FND, fundamentally, FND for many is a chronic and often relapsing condition. As I mentioned, it can certainly improve with rehabilitation. A challenge is that most of our published studies on the prognosis of FND really come from a time when we knew a lot less about the condition and we had fewer treatment options.

So these studies are somewhat difficult to apply today, but in these studies, we see that at least without treatment, most patients are the same or worse at follow-up. However, now we're starting to develop more rehabilitation programs and we have more evidence that shows that people certainly improve with rehabilitation and with therapy. There are some factors that I try to emphasize to patients as being good prognostic factors when I'm talking with them. These may be things like younger age, a shorter duration between symptom onset and diagnosis and patient agreement with the diagnosis or the perception of having control over their illness. When these types of things are present, I try to highlight them to, again, help build that hope for recovery. The one thing that I would also add maybe a bit of a different question, but I think is important to mention is that we as neurologists still have a lot to provide to our patients, even those who may not see much recovery in their symptoms and live with chronic illness.

It's really important to consider that regular check-ins. In these check-ins, we can monitor for changing perpetuating factors. We can facilitate social services, mobility aids that help overall quality of life. We can still offer a lot to our patients. The other piece that I would mention too is that our patients are at risk of iatrogenic harm. So there is definitely a role for the neurologist to look at, are there medications that might not be indicated that are causing harm? Are there other things that we can communicate clearly with other care providers to make sure that we reduce that risk for our patients?

Dr. Jon Stone:

So it's about balancing some realism, but also making sure the patient doesn't lose hope. A good outcome isn't always necessarily that symptoms gone away. It might be similar to other chronic neurological conditions that we look after where we're okay with an outcome where the patient still has symptoms if they understand their condition and can learn to live with it better. We'll be back for our final Neurology Minute episode on FND with myself and Gabriela Gilmour talking about future directions in FND. Thanks for listening.