Functional Neurological Disorder: Historical Trends and Urgent Directions

Yadira Velazquez-Rodriquez, Brooke Fehily
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Abstract

The objective was to identify the gaps in understanding and management of functional neurological disorders (FNDs) that could be negatively impacting its incidence, prevalence, prognosis, and preventive tools. A narrative review was performed to synthetize evidence from multiple fields including genetic, epidemiological, functional neuroimaging and clinical studies, paying close attention to FND historical trends and recurring themes in nomenclature, classification, epidemiology, therapeutic tools, outcomes, prognosis, and pathophysiology. References included in this review were sourced from PubMed, covering January 1, 2000 to June 30, 2022, and from the references of relevant articles. Multiple problems associated with the current status of approach and management of FNDs were identified, including six major knowledge gaps. To overcome such shortfalls, we recommend the collaborative creation of a multi-network management algorithm that integrates all pathophysiological mechanisms involved in FND onset and perpetuation. It is hoped that an integrative model will facilitate the development of a biographically focused, biopsychosocial-spiritual management and preventive protocol, which incorporates key concepts and skills from the fields of neurology, psychiatry, psychology, and physiotherapy. Such comprehensive and concise protocol could be distributed through upskill programs across several medical specialties. Multidisciplinary collaboration is needed to fill current knowledge gaps, with multispecialty teams helping to overcome the deficits in outcomes and prognosis still affecting FND, one of the commonest and most expensive neurological disorders currently affecting humankind. J Neurol Res. 2023;13(1):12-32 doi: https://doi.org/10.14740/jnr754
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功能性神经障碍:历史趋势和紧迫方向
目的是确定功能性神经障碍(FNDs)在理解和管理方面的差距,这些差距可能对其发病率、患病率、预后和预防工具产生负面影响。本文对来自遗传学、流行病学、功能神经影像学和临床研究等多个领域的证据进行了叙述性回顾,并密切关注FND的历史趋势和在命名、分类、流行病学、治疗工具、结局、预后和病理生理学方面反复出现的主题。本综述中包含的参考文献来自PubMed,涵盖2000年1月1日至2022年6月30日,以及相关文章的参考文献。确定了与疾病预防和管理现状相关的多个问题,包括六个主要的知识差距。为了克服这些不足,我们建议合作创建一个多网络管理算法,该算法集成了FND发病和延续的所有病理生理机制。希望一个综合的模式将促进以传记为中心的、生物心理社会精神管理和预防方案的发展,该方案结合了神经病学、精神病学、心理学和物理治疗领域的关键概念和技能。这种全面而简洁的协议可以通过几个医学专业的技能提升项目来分发。需要多学科合作来填补目前的知识空白,多专业团队帮助克服仍然影响FND的结果和预后缺陷,FND是目前影响人类的最常见和最昂贵的神经系统疾病之一。中华神经科杂志,2013;13(1):12-32 doi: https://doi.org/10.14740/jnr754
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