Functional neurological disorder in Europe: regional differences in education and health policy.
disability benefits
education curricula
functional neurological disorder
healthcare
patient‐led organization
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
15 Aug 2024
15 Aug 2024
Historique:
revised:
17
04
2024
received:
07
03
2024
accepted:
06
05
2024
medline:
15
8
2024
pubmed:
15
8
2024
entrez:
15
8
2024
Statut:
aheadofprint
Résumé
Functional neurological disorder (FND) is a common cause of neurological disability. Despite recent advances in pathophysiological understanding and treatments, application of this knowledge to clinical practice is variable and limited. Our aim was to provide an expert overview of the state of affairs of FND practice across Europe, focusing on education and training, access to specialized care, reimbursement and disability policies, and academic and patient-led representation of people with FND. We conducted a survey across Europe, featuring one expert per country. We asked experts to compare training and services for people with FND to those provided to people with multiple sclerosis (MS). Responses from 25 countries revealed that only five included FND as a mandatory part of neurological training, while teaching about MS was uniformly included. FND was part of final neurology examinations in 3/17 countries, unlike MS that was included in all 17. Seventeen countries reported neurologists with an interest in FND but the estimated mean ratio of FND-interested neurologists to MS neurologists was 1:20. FND coding varied, with psychiatric coding for FND impacting treatment access and disability benefits in the majority of countries. Twenty countries reported services refusing to see FND patients. Eight countries reported an FND special interest group or network; 11 reported patient-led organizations. FND is largely a marginal topic within European neurology training and there is limited access to specialized care and disability benefits for people with FND across Europe. We discuss how this issue can be addressed at an academic, healthcare and patient organization level.
Sections du résumé
BACKGROUND
BACKGROUND
Functional neurological disorder (FND) is a common cause of neurological disability. Despite recent advances in pathophysiological understanding and treatments, application of this knowledge to clinical practice is variable and limited.
OBJECTIVE
OBJECTIVE
Our aim was to provide an expert overview of the state of affairs of FND practice across Europe, focusing on education and training, access to specialized care, reimbursement and disability policies, and academic and patient-led representation of people with FND.
METHODS
METHODS
We conducted a survey across Europe, featuring one expert per country. We asked experts to compare training and services for people with FND to those provided to people with multiple sclerosis (MS).
RESULTS
RESULTS
Responses from 25 countries revealed that only five included FND as a mandatory part of neurological training, while teaching about MS was uniformly included. FND was part of final neurology examinations in 3/17 countries, unlike MS that was included in all 17. Seventeen countries reported neurologists with an interest in FND but the estimated mean ratio of FND-interested neurologists to MS neurologists was 1:20. FND coding varied, with psychiatric coding for FND impacting treatment access and disability benefits in the majority of countries. Twenty countries reported services refusing to see FND patients. Eight countries reported an FND special interest group or network; 11 reported patient-led organizations.
CONCLUSIONS
CONCLUSIONS
FND is largely a marginal topic within European neurology training and there is limited access to specialized care and disability benefits for people with FND across Europe. We discuss how this issue can be addressed at an academic, healthcare and patient organization level.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e16350Subventions
Organisme : Charles University
ID : CooperatioNeuroscience
Organisme : General University Hospital in Prague
ID : MHCZ-DRO-VFN64165
Informations de copyright
© 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21:537‐550. doi:10.1016/S1474-4422(21)00422-1
Carson A, Lehn A. Epidemiology. Handb Clin Neurol. 2016;139:47‐60. doi:10.1016/B978-0-12-801772-2.00005-9
O'Mahony B, Nielsen G, Baxendale S, Edwards MJ, Yogarajah M. Economic cost of functional neurologic disorders: a systematic review. Neurology. 2023;101:e202‐e214. doi:10.1212/WNL.0000000000207388
Perez DL, Edwards MJ, Nielsen G, Kozlowska K, Hallett M, LaFrance WC Jr. Decade of progress in motor functional neurological disorder: continuing the momentum. J Neurol Neurosurg Psychiatry. 2012;92:668‐677. doi:10.1136/jnnp-2020-323953
Gilmour GS, Nielsen G, Teodoro T, et al. Management of functional neurological disorder. J Neurol. 2020;267:2164‐2172. doi:10.1007/s00415-020-09772-w
Espay AJ, Lang AE. Phenotype‐specific diagnosis of functional (psychogenic) movement disorders. Curr Neurol Neurosci Rep. 2015;15:32. doi:10.1007/s11910-015-0556-y
Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64. doi:10.1136/bmj.o64
Gutkin M, McLean L, Brown R, Kanaan RA. Systematic review of psychotherapy for adults with functional neurological disorder. J Neurol Neurosurg Psychiatry. 2020;92:36‐44. doi:10.1136/jnnp-2019-321926
Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015;86:1113‐1119. doi:10.1136/jnnp-2014-309255
Di Vico IA, Serranova T, Colombari M, et al. Gaps in functional motor disorders care in two European countries: time to address shared terminology, medico‐legal barriers and public investments. Eur J Neurol. 2021;28:3921‐3924. doi:10.1111/ene.15092
Tinazzi M, Fiorio M, Berardelli A, et al. Opinion, knowledge, and clinical experience with functional neurological disorders among Italian neurologists: results from an online survey. J Neurol. 2022;269:2549‐2559. doi:10.1007/s00415-021-10840-y
Alqassas M, Alatiyah MH, Aldharman SS, et al. Approach and clinical practice of functional movement disorders among neurologists in Saudi Arabia. Cureus. 2022;14:e32770. doi:10.7759/cureus.32770
LaFaver K, Lang AE, Stone J, et al. Opinions and clinical practices related to diagnosing and managing functional (psychogenic) movement disorders: changes in the last decade. Eur J Neurol. 2020;27:975‐984.
Lehn A, Bullock‐Saxton J, Newcombe P, Carson A, Stone J. Survey of the perceptions of health practitioners regarding functional neurological disorders in Australia. J Clin Neurosci. 2019;67:114‐123. doi:10.1016/j.jocn.2019.06.008
Xie XY, Lin GZ, Huang Q, et al. Opinions and clinical practice of functional movement disorders: a nationwide survey of clinicians in China. BMC Neurol. 2021;21:435. doi:10.1186/s12883-021-02474-4
de Liege A, Carle G, Hingray C, et al. Functional neurological disorders in the medical education: an urgent need to fill the gaps. Rev Neurol. 2022;178:788‐795. doi:10.1016/j.neurol.2022.03.018
Milligan TA, Yun A, LaFrance WC Jr, et al. Neurology residents' education in functional seizures. Epilepsy Behav Rep. 2022;18:100517. doi:10.1016/j.ebr.2021.100517
Tinazzi M, Gandolfi M, Landi S, Leardini C. Economic costs of delayed diagnosis of functional motor disorders: preliminary results from a cohort of patients of a specialized clinic. Front Neurol. 2021;12:786126. doi:10.3389/fneur.2021.786126
Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry. 2021;92:1112‐1125. doi:10.1136/jnnp-2021-326767
Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry. 2020;91:1037‐1045. doi:10.1136/jnnp-2019-322281
Colombari M, di Vico IA, Turrina S, de Leo D, Tinazzi M. Medico‐legal aspects of functional neurological disorders: time for an interdisciplinary dialogue. Neurol Sci. 2021;42:3053‐3055. doi:10.1007/s10072-021-05162-w
FND Hope UK. CCG/Health Board Report 2022. 2022. https://www.fndhope.org.uk/wp‐content/uploads/2023/08/FND‐Hope‐UK‐Freedom‐of‐Information‐Report‐for‐CCGs‐and‐Health‐Boards‐2022‐V1.0.pdf.pdf
World Health Organizaion (WHO). International Statistical Classification of Diseases, 10th Revision. WHO; 2004.
World Health Organizaion (WHO). International Statistical Classification of Diseases, 11th Revision. WHO; 2018.
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; 2013.
Walton C, King R, Rechtman L, et al. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Mult Scler. 2020;26:1816‐1821. doi:10.1177/1352458520970841
Carson A, Stone J, Hibberd C, et al. Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease’. J Neurol Neurosurg Psychiatry. 2011;82:810‐813. doi:10.1136/jnnp.2010.220640
Bassetti CLA. European Academy of Neurology 2019–2022. Eur J Neurol. 2022;29:2567‐2571. doi:10.1111/ene.15421
European Academy of Neurology. European training requirements for neurology. 2021. https://www.ean.org/learn/career‐development/european‐curricula
Joint Royal Colleges of Physicians Training Board. Curriculum for neurology training. 2022. https://www.gmc‐uk.org
Finkelstein SA, O'Neal MA, Baslet G, et al. Developing a curriculum for functional neurological disorder in neurology training: questions and answers. Neurol Clin. 2023;41:711‐728. doi:10.1016/j.ncl.2023.02.007
Ellenstein A, Kranick SM, Hallett M. An update on psychogenic movement disorders. Curr Neurol Neurosci Rep. 2011;11:396‐403. doi:10.1007/s11910-011-0205-z
Kranick SM, Gorrindo T, Hallett M. Psychogenic movement disorders and motor conversion: a roadmap for collaboration between neurology and psychiatry. Psychosomatics. 2011;52:109‐116. doi:10.1016/j.psym.2010.12.017
Aatti Y, Schwan R, Maillard L, et al. A cross‐sectional survey on French psychiatrists' knowledge and perceptions of psychogenic nonepileptic seizures. Epilepsy Behav. 2016;60:21‐26. doi:10.1016/j.yebeh.2016.04.023
Dent B, Stanton BR, Kanaan RA. Psychiatrists' understanding and management of conversion disorder: a bi‐national survey and comparison with neurologists. Neuropsychiatr Dis Treat. 2020;16:1965‐1974. doi:10.2147/NDT.S256446
Filippi M, Danesi R, Derfuss T, et al. Early and unrestricted access to high‐efficacy disease‐modifying therapies: a consensus to optimize benefits for people living with multiple sclerosis. J Neurol. 2022;269:1670‐1677. doi:10.1007/s00415-021-10836-8
Goudarzi MH, Eadie MJ, Hollingworth SA. Disease modifying therapies for relapsing‐remitting multiple sclerosis: use and costs in Australia (1996–2019). Mult Scler Relat Disord. 2021;50:102835. doi:10.1016/j.msard.2021.102835
Finkelstein SA, Carson A, Edwards MJ, et al. Setting up functional neurological disorder treatment services: questions and answers. Neurol Clin. 2023;41:729‐743. doi:10.1016/j.ncl.2023.04.002
National Neurosciences Advisory Group. Optimal Clinical Pathway for Adults with Functional Neurological Disorder. 2023. https://www.nnag.org.uk/optimal‐clinical‐pathway‐adults‐fnd‐functional‐neurological‐disorder