What Is the Role of a Specialist Assessment Clinic for FND? Lessons From Three National Referral Centers
Abstract
Objective:
Methods:
Results:
Conclusions:
Experiences of Three New Referral Centers
United Kingdom
Switzerland
Canada
Methods
Variable | United Kingdom | Switzerland | Canada |
---|---|---|---|
Opening of the clinic | September 2008 | October 2016 | November 2017 |
Study inclusion criteria | Consecutive patients with a confirmed functional movement disorder (FMD) | Consecutive patients with suspected FND | Patients with FMD referred to neuropsychiatry |
Study period | April 30, 2017–February 9, 2018 | November 1, 2016–February 1, 2018 | January 1, 2018–December 30, 2018 |
Method of data collection | Chart review | Chart review | Chart review |
Diagnosis assessment | 4 neurologists | 3 neurologists | 10 neurologists |
Duration of neurological first assessment | 1 hour | 1.5 hours | 1 hour |
Duration of neurological follow-up | 30 minutes | 1 hour | 30 minutes |
Interdisciplinary follow-up | Depending on the treatment program, with a neurologist, a physiotherapist, or a neuropsychiatrist | Joint sessions of 30 minutes with a neurologist, then 30 minutes with a psychologist, and then 30 minutes with both together; independent individual sessions with a physiotherapist and an occupational therapist | Integrated clinic, with 45 minutes with a neurologist, a neuropsychiatrist, and a physiotherapist |
Duration of interdisciplinary treatment | 5 days to 12 weeks, depending on the program | 3 months to a maximum of 6 months, with weekly physiotherapy and monthly joint sessions | 3 months, with biweekly visits |
Network | Inpatient multidisciplinary rehabilitation, outpatient psychology and neuropsychiatry, day-case pain management program, 5-day specialist physiotherapy program | Pain clinic, psychosomatic medicine specialists, inpatient multidisciplinary rehabilitation in rehabilitation clinics | Community physiotherapy, outpatient neuropsychiatry |
Results
United Kingdom | Switzerland | Canada | ||||
---|---|---|---|---|---|---|
Characteristic | N | % | N | % | N | % |
Sociodemographic | ||||||
N of patients in cohort | 100 | — | 302 | — | 90 | — |
Age (M±SD) | 42.5±14.2 | 44±15 | 46±16 | |||
Sex | ||||||
Male | 20 | 37 | 25 | |||
Female | 80 | 63 | 75 | |||
Employment status | ||||||
Paid employment (full- or part-time) | 19 | 48 | 23 | |||
Retired or not working (nonmedical reasons) | 7 | 17 | 6 | |||
Not working because of ill health | 39 | 25 | 40 | |||
Student | 7 | 6 | 8 | |||
Volunteer work | 1 | 0 | — | 1 | ||
Unknown | 27 | 4 | 21 | |||
Benefits and social help | ||||||
Receives disability benefit | 34 | 15 | 28 | |||
Receives unemployment benefit | NR | 4 | NR | |||
Refugee | NR | 2 | NR | |||
Assistance for personal care | ||||||
Paid caregiver (social services funded) | 14 | NR | 1 | |||
Unpaid caregiver (family or friends) | 24 | NR | 9 | |||
No assistance needed | 37 | NR | 67 | |||
Unknown | 25 | NR | 23 | |||
Diagnostic | ||||||
Final diagnosis of FND | 100 | 100 | 183 | 90 | 100 | |
Motor FND (ICD-10-CM, F44.4) | 46 | 69 | 38 | 9 | 10 | |
Gait | 18 | 20 | 11 | 6 | 7 | |
Predominant weakness | 28 | 49 | 27 | 3 | 3 | |
Abnormal movement (ICD-10-CM, F44.4) | 48 | 43 | 23 | 81 | 90 | |
FMD tremor | 8 | NR | 15 | 17 | ||
FMD facial symptom | 5 | NR | 7 | 8 | ||
FMD dystonia | 5 | NR | 9 | 10 | ||
FMD fixed dystonia | 3 | NR | 1 | 1 | ||
FMD jerks | 3 | NR | 7 | |||
FMD parkinsonism | 0 | — | NR | 1 | ||
FMD chorea | 1 | NR | 0 | — | ||
FMD mixed symptoms | 24 | NR | 42 | 47 | ||
Sensory (ICD-10-CM, F44.5) | 0 | — | 19 | 10 | 0 | — |
Psychogenic nonepileptic seizures (PNES) (ICD-10-CM, F44.6) | 0 | — | 23 | 13 | 0 | — |
Mixed (ICD-10-CM, F44.7) (FMD+PNES) | 19 | 29 | 16 | 18 | ||
Other | 6 | 0 | — | 0 | — | |
Pain without motor symptoms on examination | 4 | NR | 1 | |||
Dizziness without motor symptoms | 1 | NR | 0 | — | ||
Parkinson’s disease with functional overlay | 1 | NR | 2 | |||
FND with persistent pain as a significant problem | 79 | NR | 56 | |||
FND with fatigue as a significant problem | 48 | NR | 47 | |||
Duration and presentation of symptoms | ||||||
Mean duration (M±SD years) | 6.7±6.1 | 4±6 | 7.4±8.1 | |||
Median duration (years) | 5.0 | 2.3 | 4.0 | |||
Paroxysmal presentation of FND symptom | 25 | NR | 29 |
Discussion and Lessons Learned
Lesson 1
FND is a syndrome with multiple comorbidities, and specialized neurological evaluation is useful for specific patients.
Lesson 2
A high percentage of patients require physical rehabilitation, and specialized services are needed.
Lesson 3
Neuropsychiatric evaluation and treatment specific to FND are needed.
Lesson 4
Earlier detection and treatment of FND are needed.
Conclusions
Supplementary Material
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