title: Inpatient treatment of functional motor symptoms: a long-term follow-up study.
abstract: Functional neurological disorders are common, disabling and often difficult to treat. There is little consensus on the best approach to management. Multidisciplinary inpatient approaches are employed in some centres for patients with severe refractory symptoms, but their efficacy and, in particular, long-term outcomes are uncertain. We conducted a study using questionnaires completed retrospectively by patients treated at a specialised multidisciplinary inpatient programme at the National Hospital for Neurology and Neurosurgery. Consecutive patients with functional motor symptoms admitted to this centre between 2006 and 2008 were invited to participate. Questionnaires were sent at least 2 years after discharge. We contacted 32 patients, and 26 responded. The majority had symptoms for at least 3 years prior to admission; 58 % of patients reported benefit from the programme on discharge. This self-reported benefit to symptoms and function was after a 2-year follow-up period in the majority of patients, but return to work or cessation of health-related financial benefits was uncommon even in those who improved. Seventy-four percent of those questioned stated they would recommend the programme to others with similar symptoms. Attribution of symptoms to stress or emotional state was correlated with favourable outcome. Our data suggest that multidisciplinary inpatient treatment for patients with refractory functional motor symptoms provides self-reported benefit in the long-term. Prospective analysis of such interventions and the determinants of benefit need assessment in order to improve the service and target treatment to patients most likely to benefit.
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
authors.forename: T A
authors.initials: TA
authors.lastname: Saifee
authors.forename: P
authors.initials: P
authors.lastname: Kassavetis
authors.forename: I
authors.initials: I
authors.lastname: Pareés
authors.forename: M
authors.initials: M
authors.lastname: Kojovic
authors.forename: L
authors.initials: L
authors.lastname: Fisher
authors.forename: L
authors.initials: L
authors.lastname: Morton
authors.forename: J
authors.initials: J
authors.lastname: Foong
authors.forename: G
authors.initials: G
authors.lastname: Price
authors.forename: E M
authors.initials: EM
authors.lastname: Joyce
authors.forename: M J
authors.initials: MJ
authors.lastname: Edwards
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007297:Inpatients; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology; D009069:Movement Disorders / Q000209:etiology* / Q000534:rehabilitation*; D009422:Nervous System Diseases / Q000150:complications*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires