Multidisciplinary group-based interventions for patients with functional neurological disorder

Abstract

Background: Functional Neurological Disorder (FND) is a condition characterized by altered brain functioning in the absence of structural abnormalities. It is classified in diagnostic manuals within the category of dissociative or conversion disorders. Symptoms are typically characterized by inconsistency and incongruence on neurological examination, with the most common manifestations including weakness or paralysis, abnormal movements, impaired balance, and non-epileptic seizures. FND has a multifactorial etiology, and psychiatric comorbidities are frequently present. In this context, multidisciplinary rehabilitation has been recommended in the literature. Objective: The aim of the present study is to describe a set of multidisciplinary group-based activities developed for patients with functional movement disorder at a neurological rehabilitation center. Methods: 17 female patients with a confirmed diagnosis of FND previously established in the outpatient clinic were initially selected. The team contacted each participant in advance to assess interest and availability. 14 patients confirmed participation and were scheduled. Two participants were excluded due to at least three consecutive absences. An activity schedule was developed consisting of eight weekly sessions, each lasting two hours. The program included an educational session about the disorder, an interactive group involving patients and caregivers, body awareness and dance activities, gametherapy and SmartLab sessions, physiotherapy-guided exercises, and a socialization experience involving elements of popular culture. Quality of life was assessed using the WHOQOL-BREF before and after the intervention. Results: The age of participants ranged from 28 to 57 years (mean 45.4 years). The average attendance per session was 10.8 participants. WHOQOL-BREF scores showed a positive change in category from “Needs Improvement” to “Fair” in the General Health and Environment domains. In the remaining domains (Physical, Psychological, and Social Relationships), the classification remained “Needs Improvement.” Notably, the intervention provided important benefits regarding group interaction, bond formation, social exchange, a sense of belonging, and emotional support, as well as increased motivation and improvements in coping processes. Conclusion: Rehabilitation of patients with Functional Neurological Disorder should involve multidisciplinary approaches, and benefits can be enhanced through group-based interventions. This study highlights the importance of considering the individual as a whole and of exploring new strategies to achieve the proposed objectives.