What non-pharmacological management strategies are effective for patients diagnosed with FND?

Effective non-pharmacological management strategies for patients diagnosed with functional neurological disorder (FND) include:

• Psychological support: Cognitive behavioural therapy (CBT) is recommended, especially for functional seizures, to identify triggers and use sensory grounding techniques to prevent events. Psychoeducation helps increase awareness of triggers, reduce stress, and address unhelpful illness beliefs and behaviours.
• Physiotherapy: Focuses on motor symptoms by reinforcing normal movements and using attentional redirection techniques (e.g., music or talking) to facilitate 'brain retraining' and help movements become more automatic. Visual feedback using mirrors or video can aid motor relearning.
• Occupational therapy and speech and language therapy: These therapies support recovery by focusing on day-to-day activities and tasks to promote functional improvement.
• Social support: Encouraging independence and autonomy through social support can aid recovery and reduce relapse risk.
• Multidisciplinary team (MDT) approach: A holistic, individualized treatment plan involving neurology, physiotherapy, psychology, occupational therapy, and speech therapy tailored to the person's needs and wishes is beneficial.
• Self-management and education: Providing information, self-help techniques, and relapse plans focusing on improving function rather than solely reducing symptoms is important, but education alone without follow-up is insufficient.

Adaptive equipment like wheelchairs or house adaptations should be avoided if the person has rehabilitation potential, to promote autonomy and reduce dependency.

Management of comorbid conditions such as depression and anxiety is also important as these can exacerbate FND symptoms.

Referral to neurology or specialist services is advised for confirmation of diagnosis, complex symptoms, or if symptoms relapse despite optimal management.

Sources of patient support include websites like neurosymptoms.org, fndaction.org.uk, and fndhope.org, and apps like MyFND for symptom tracking and self-management.

All these strategies aim to improve function and quality of life by addressing the neurological, psychological, and social aspects of FND.

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