Identifying and evaluating novel treatment targets for the development of evidence-based interventions for Functional Neurological Disorder
Open accessAbstract
Historically, functional neurological disorder (FND) has been described in psychodynamic terms as the physical manifestation of psychological distress. It is often explained to patients and caregivers as the result of anxiety, stress, trauma or other psychiatric comorbidities. However, recent evidence indicates that targeting mood and stress is not equivalent to the treatment of FND and may have limited to no effect on FND symptoms. Given the few randomized controlled trials for FND treatments and the limited evidence of mood and stress as effective treatment targets, the identification and evaluation of novel treatment targets or mediators is an area of great opportunity and should be the focus of future research. Identifying and targeting modifiable disease mechanisms directly as opposed to only treating psychiatric comorbidities may result in greater efficacy in treating FND symptoms, better patient outcomes and lower healthcare costs. Several novel mechanisms have been identified that warrant additional investigation as potential treatment targets including abnormal attentional focus on the affected area, beliefs and expectations about illness, impairments in habituation, and decreased sense of control over actions. Future intervention studies should take a mechanism-based approach and utilize valid and reliable measures or specific biomarkers to determine whether improvements in FND symptoms are associated with changes in the treatment targets. This transdiagnostic approach will allow researchers to translate the novel mechanistic outcomes emerging from neurophysiological and neuroscience studies into new or improved evidence-based approaches to FND treatment and prevention.
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Expectations regarding negative or catastrophic symptoms and a low sense of control over symptoms have been identified as important factors for maintaining FND symptoms, including functional seizures.
“In addition, expectations regarding negative or catastrophic symptoms (known as “catastrophic symptom expectations”) and a low sense of control over symptoms have been identified as important factors for maintaining FND symptoms (including functional seizures) [67,68].”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [68]
The paper identifies beliefs and expectations about illness and decreased sense of control as potential treatment targets for FND (section labeled Abstract; page unavailable). It also reports that a treatment targeting catastrophic symptom expectations and sense of control reduced functional seizures in children. But it says these targets need further investigation and have not been confirmed as the mechanisms of improvement, so it does not establish them as factors maintaining symptoms. (LLM, conf=0.87)
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Tolerating uncertainty to treat functional motor disorder
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- Authors
- Fobian, A. D., & Szaflarski, J. P.
- Affiliations
- University of Alabama at Birmingham (US)
- Corresponding author
- Fobian, Aaron D.
- Venue
- Epilepsy & Behavior Reports
- Publisher
- Elsevier BV
- Published
- 2021
- Volume
- 16
- Pages
- 100479
- ISSN
- 2589-9864 (ISSN-L)
- PMC
- PMC8449163
- OpenAlex
- W3198609849
- Cited by
- 21
- References
- 41
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 1 · 2023: 3 · 2022: 6 · 2021: 3
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Epilepsy & Behavior Reports (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. Department of Defense
- National Institute of Mental Health
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- conversion disorder, treatment goals, disease mechanisms, attentional focus, habituation, perceived control, transdiagnostic approach, biomarkers, psychodynamic model, psychiatric comorbidity
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