Functional Neurologic Disorder Series - Part 7

In the final episode of this seven-part series, Dr. Jon Stone and Dr. Gabriela Gilmour wrap up the conversation discussing future directions. 

Show citations:

Functional Neurological Disorder Society

Finkelstein SA, Carson A, Edwards MJ, et al. Setting up Functional Neurological Disorder Treatment Services: Questions and Answers. Neurol Clin. 2023;41(4):729-743. doi:10.1016/j.ncl.2023.04.002 

Show transcript: 

Dr. Gabriela Gilmour:

This is Gabriela Gilmour with the Neurology Minute. Jon Stone and I are back for our final episode of our seven-part series on functional neurological disorder. Today, we will discuss future directions for the field of FND. So Jon, where do you see the field of FND going in terms of diagnosis and treatment?

Dr. Jon Stone:

So we've seen a tremendous increase in interest in FND, particularly in the last five years since we started the FND Society. I think there's much more awareness of making rule-in diagnoses compared to before. There's much more positivity about treatment and I think people who experience their own patients doing very well with treatment makes them want to see that again.

But we've got a long way to go. I think the diagnostic ruling features that we talked about in an earlier episode are still largely clinical. I think we could really benefit from seeing those becoming more laboratory supported, particularly for research, particularly for looking at FND comorbidity and other neurological conditions like MS and Parkinson's. So I think we might see more of that, AI helping us with that maybe, but things like quantifying some of the physical signs that we use.

In terms of treatment, I think it's great all the different ideas about treatment that we've had and we know that the rehabilitation therapy for FND benefits from a more FND focused approach. But we have to be honest as well and say that the treatments, there's still large numbers of patients who are not improving. And so we do need to think about other ways to help people. People are interested in treatments, modalities such as using virtual reality, people looking at medications such as psychedelics or things like that. We've got to be careful with that obviously in peoples where their brains don't work properly. But I think we can do better than we are and people are exploring those options interestingly.

Dr. Gabriela Gilmour:

Yeah. And I think on the note of treatment, as we've sort of spoken through this podcast series, we've talked about places or environments where there's already services set up for patients. And so I think another major goal for the future for the FND Society is to build more services and have more expertise and knowledge across the world. What would you tell neurologists to do or how would you support them if they don't have other health professionals to help in their local environment?

Dr. Jon Stone:

Well, I'm aware that that's probably what most neurologists feel like. That they can recognize FND, but they don't have people to refer to or therapists who know about FND. So I certainly share that frustration. What I would say has happened locally here in Edinburgh, and also I see this in other centers as well. If you just start referring patients, helping to send patients to your colleagues who want to have therapy, educating your colleagues, then the people around you can develop that expertise that's needed. You don't necessarily need a whole new team.

If you're an enthusiastic neurologist interested in FND, be careful about doing it just on your own because I think there's a lot of good you can do, but it'd be quite easy to burn out there without some help. So I think it's a slow process of gathering together interested health professionals. Ideally, of course, you want to have a psychologist to do therapy, a psychiatrist for more detailed assessments of complex patients, physio, OT, speech and language therapy.

Once you get that, what I find is that then locally, they will start to teach each other because this is work that most people in rehabilitation actually enjoy when they know how to do it. They like seeing people with FND. They like the fact that this is a disorder that will often be static for many years or a long time anyway, and where therapy can actually change that trajectory. So just sort of hang in there. There are articles you can read about more details about how to set up services and think about that as well.

Dr. Gabriela Gilmour:

Well, thank you so much, Jon, for joining me for this series. This is our final episode of the Neurology Minute series on Functional Neurological Disorder. And thank you to all of our listeners.

Dr. Jon Stone:

Thank you very much, Gabriela.