Long-Term Outcome of Motor Functional Neurological Disorder After Rehabilitation
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. We performed a single-center retrospective study aimed at determining the long-term outcome of FND patients receiving inpatient rehabilitation and the predictors of a good outcome. Methods A multidisciplinary graded exercise program was provided with one or two daily physiotherapy and occupational therapy sessions on 5 days each week, as well as weekly psychological support. Outcome was assessed using the motor part of the Functional Independence Measure scale (FIM; maximum score of 91) at admission, discharge, and follow-up, with the last assessment performed by phone interview. Results The 30 included patients were aged 43.6±14.7 years (mean±standard deviation), comprised 70% females, and received a mean of 4 weeks of rehabilitation. The admission FIM score (80.2±8.3) was significantly lower than the discharge FIM score (86.9±4.6; p<0.001, Wilcoxon signed-rank test). No notable difference was observed between discharge and follow-up FIM scores (85.5±8.5, p=0.54). The mean follow-up of the 36-month FIM scores at discharge and follow-up was dichotomized as a good outcome in cases where all items were scored ≥6 (functional independence). Binomial logistic regression showed that absence of a comorbid psychiatric disorder (p=0.039, odds ratio=10.7) was a predictive factor for a good outcome at follow-up. Other variables (e.g., sex and age) were not significant predictors of clinical outcome (all p≥0.058). Conclusions These results suggest inpatient intensive rehabilitation for motor FND is effective and produces favorable long-term results. Further studies with larger groups are warranted so that the management protocols can be standardized.
Abstract
Background and Purpose Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. We performed a single-center retrospective study aimed at determining the long-term outcome of FND patients receiving inpatient rehabilitation and the predictors of a good outcome. Methods A multidisciplinary graded exercise program was provided with one or two daily physiotherapy and occupational therapy sessions on 5 days each week, as well as weekly psychological support. Outcome was assessed using the motor part of the Functional Independence Measure scale (FIM; maximum score of 91) at admission, discharge, and follow-up, with the last assessment performed by phone interview. Results The 30 included patients were aged 43.6±14.7 years (mean±standard deviation), comprised 70% females, and received a mean of 4 weeks of rehabilitation. The admission FIM score (80.2±8.3) was significantly lower than the discharge FIM score (86.9±4.6; p<0.001, Wilcoxon signed-rank test). No notable difference was observed between discharge and follow-up FIM scores (85.5±8.5, p=0.54). The mean follow-up of the 36-month FIM scores at discharge and follow-up was dichotomized as a good outcome in cases where all items were scored ≥6 (functional independence). Binomial logistic regression showed that absence of a comorbid psychiatric disorder (p=0.039, odds ratio=10.7) was a predictive factor for a good outcome at follow-up. Other variables (e.g., sex and age) were not significant predictors of clinical outcome (all p≥0.058). Conclusions These results suggest inpatient intensive rehabilitation for motor FND is effective and produces favorable long-term results. Further studies with larger groups are warranted so that the management protocols can be standardized.
참고문헌 (38)
- Espay AJ, "Current concepts in diagnosis and treatment of Functional Neurological Disorders", JAMA Neurol, 75, pp.1132~1141 (2018)
- Raynor G, "A historical review of functional neurological disorder and comparison to contemporary models", Epilepsy Behav Rep, 16, pp.100489~ (2021)
- American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders", pp.414~418 (2013), American Psychiatric Association
- Carson A, "Epidemiology", Handb Clin Neurol, 139, pp.47~60 (2016)
- Stone J, "Who is referred to neurology clinics?-the diagnoses made in 3781new patients", Clin Neurol Neurosurg, 112, pp.747~751 (2010)
- Hallett M, "Functional neurological disorder : new subtypes and shared mechanisms", Lancet Neurol, 21, pp.537~550 (2022)
- Aybek S, "Diagnosis and management of functional neurological disorder", BMJ, 376, pp.o64~ (2022)
- Perez DL, "Neuroimaging in functional neurological disorder : state of the field and research agenda", Neuroimage Clin, 30, pp.102623~ (2021)
- Boeckle M, "Neural correlates of conversion disorder : overview and meta-analysis of neuroimaging studies on motor conversion disorder", BMC Psychiatry, 16, pp.195~ (2016)
- O’Neal MA, "Treatment for patients with a functional neurological disorder(conversion disorder) : an integrated approach", AM J Psychiatry, 175, pp.307~314 (2018)
- Russell L, "A review of the treatment of functional neurological disorder with intensive short-term dynamic psychotherapy", Epilepsy Behav, 130, pp.108657~ (2022)
- Goldstein LH, "Psychologic treatment of functional neurologic disorders", Handb Clin Neurol, 139, pp.571~583 (2016)
- Nielsen G, "Physiotherapy for functional(psychogenic)motor symptoms : a systematic review", J Psychosom Res, 75, pp.93~102 (2013)
- Schönfeldt-Lecuona C, "Non-invasive brain stimulation in conversion(functional)weakness and paralysis : a systematic review and future perspectives", Front Neurosci, 10, pp.140~ (2016)
- Lefaucheur JP, "Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation(rTMS) : an update(2014-2018)", Clin Neurophysiol, 131, pp.474~528 (2020)
- Garcin B, "Transcranial magnetic stimulation as an efficient treatment for psychogenic movement disorders", J Neurol Neurosurg Psychiatry, 84, pp.1043~1046 (2013)
- Chastan N, "Psychogenic paralysis and recovery after motor cortex transcranial magnetic stimulation", Mov Disord, 25, pp.1501~1504 (2010)
- Delargy MA, "Successful rehabilitation in conversion paralysis", Br Med J(Clin Res Ed), 292, pp.1730~1731 (1986)
- Perez DL, "Decade of progress in motor functional neurological disorder : continuing the momentum", J Neurol Neurosurg Psychiatry, 92, pp.668~677 (2021)
- Gilmour GS, "Inpatient treatment of functional neurological disorder : a scoping review", Can J Neurol Sci, 48, pp.204~217 (2021)
- Nielsen G, "Physiotherapy for functional motor disorders : a consensus recommendation", J Neurol Neurosurg Psychiatry, 86, pp.1113~1119 (2015)
- Nicholson C, "Occupational therapy consensus recommendations for functional neurological disorder", J Neurol Neurosurg Psychiatry, 91, pp.1037~1045 (2020)
- Heruti R, "Conversion motor paralysis disorder : overview and rehabilitation model", Spinal Cord, 40, pp.327~334 (2002)
- Czarnecki K, "Functional movement disorders : successful treatment with a physical therapy rehabilitation protocol", Parkinsonism Relat Disord, 18, pp.247~251 (2012)
- Jordbru AA, "Psychogenic gait disorder : a randomized controlled trial of physical rehabilitation with one-year follow-up", J Rehabil Med, 46, pp.181~187 (2014)
- Gelauff J, "Prognosis of functional neurologic disorders", Handb Clin Neurol, 139, pp.523~541 (2016)
- Keith RA, "The functional independence measure : a new tool for rehabilitation", Adv Clin Rehabil, 1, pp.6~18 (1987)
- Linacre JM, "The structure and stability of the functional independence measure", Arch Phys Med Rehabil, 75, pp.127~132 (1994)
- Smith P, "Intermodal agreement of follow-up telephone functional assessment using the functional independence measure in patients with stroke", Arch Phys Med Rehabil, 77, pp.431~435 (1996)
- Polich G, "Development of an inpatient rehabilitation pathway for motor functional neurological disorders : initial reflections", NeuroRehabilitation, 50, pp.231~243 (2022)
- Theuer RV, "Rehabilitation for motor functional neurological disorder : a follow-up study of 185 patients", Arq Neuropsiquiatr, 78, pp.331~336 (2020)
- Saifee TA, "Inpatient treatment of functional motor symptoms : a long-term follow-up study", J Neurol, 259, pp.1958~1963 (2012)
- Speed J, "Behavioral management of conversion disorder : retrospective study", Arch Phys Med Rehabil, 77, pp.147~154 (1996)
- Couprie W, "Outcome in conversion disorder : a follow up study", J Neurol Neurosurg Psychiatry, 58, pp.750~752 (1995)
- Binzer M, "Motor conversion disorder. A prospective 2-to 5-year follow-up study", Psychosomatics, 39, pp.519~527 (1998)
- Green SL, "Apathy and depression as predictors of activities of daily living following stroke and traumatic brain injuries in adults : a meta-analysis", Neuropsychol Rev, 32, pp.51~69 (2022)
- Mace CJ, "Ten-year prognosis of conversion disorder", Br J Psychiatry, 169, pp.282~288 (1996)
- Gelauff J, "The prognosis of functional(psychogenic)motor symptoms : a systematic review", J Neurol Neurosurg Psychiatry, 85, pp.220~226 (2014)