Functional Neurologic Disorders

Jon Stone, MB, ChB, FRCP, PhD; Alan Carson, MD, MPhil, MRCPsych, FRCP Behavioral Neurology and Neuropsychiatry p. 818-837 June 2015, Vol.21, No.3 doi: 10.1212/01.CON.0000466669.02477.45
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Purpose of Review:: Functional neurologic disorders, also called psychogenic, nonorganic, conversion, and dissociative disorders, are among the most common problems in neurologic practice. This article presents a practical guide to clinical assessment and treatment, incorporating emerging research evidence. This article places an emphasis on encouraging neurologists to use the assessment as treatment, take an active role in educating and treating the patient, and work in a multidisciplinary way with psychiatry, psychology, and physical therapy.

Recent Findings:: Classification of functional neurologic disorders now emphasizes the importance of positive diagnosis based on physical signs, not psychological features. Studies of mechanism have produced new clinical and neurobiological ways of thinking about these disorders. Evidence has emerged to support the use of physical therapy for functional movement disorders and psychotherapy for dissociative (nonepileptic) attacks.

Summary:: The diagnosis and management of functional neurologic disorders has entered a new evidence-based era and deserves a standard place in the neurologic curriculum.

Address correspondence to Dr Jon Stone, Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK EH4 2XU, jon.stone@ed.ac.uk.

Relationship Disclosure: Dr Stone receives personal compensation for expert testimony related to personal injury and negligence cases from multiple UK law firms and receives royalties from UpToDate, Inc. Dr Stone has received honoraria for lectures from the British Medical Association and Novartis AG and travel compensation from the European Neurological Society, Movement Disorders Society, Royal College of Psychiatrists, and from neurology departments in Amsterdam, Cork, Leuven, Oxford, Reykjavík, and St Louis.

Dr Carson receives personal compensation for expert testimony related to personal injury and negligence cases and has received honoraria for lectures from Novartis AG and UCB, Inc. Dr Carson serves as associate editor of the Journal of Neurology, Neurosurgery, and Psychiatry, serves as president of the executive committee of The British NeuroPsychiatry Association, and receives book royalties from BMJ Books.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Stone and Carson discuss the unlabeled/investigational use of antidepressant medication and transcranial magnetic stimulation for treating functional disorders.

Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and app versions of this article; the URLs are provided in the print version. Video legends begin on page 833.

© 2015 American Academy of Neurology