Functional Neurological Disorder: Historical Trends and Urgent Directions

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