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MULTIDISCIPLINARY INPATIENT PROGRAMME FOR FUNCTIONAL NEUROLOGICAL SYMPTOMS: A PROSPECTIVE STUDY ASSESSING EFFICACY AND PREDICTORS OF GOOD OUTCOME
  1. Benedetta Demartini,
  2. Panayiota Petrochilos,
  3. Mark J Edwards,
  4. Eileen Joyce
  1. Sobell Department, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK

Abstract

Objective Although functional neurological symptoms (FNS) are often very disabling, little is known about their long-term prognosis and about the best approaches to treatment. Inpatient treatment programmes combining different approaches have been described but the lack of controlled studies and the expensiveness of the intervention have limited their use. Here we aimed to assess the short- and long-term efficacy of an inpatient multidisciplinary programme for patients with FNS. We also sought to determine baseline predictors of good outcome. Finally we aimed to assess the responsiveness of different psychological and physical scales administered at admission, discharge and follow-up.

Method Sixty-six consecutive patients affected by FNS treated at a specialised multidisciplinary inpatient programme were included. The assessment at admission, discharge and at 1-year follow-up included: the Health of the Nation Outcome Scale (HoNOS), the Hospital Anxiety and Depression Scale (HADS), the Patient Heath Questionnaire-15 (PHQ-15), the Revised Illness Perception Questionnaire (IPQ-R), the Common Neurological Symptom Questionnaire, the Fear Questionnaire (FQ) and the Canadian Occupational Performance Measure (COPM). At discharge and at 1-year follow-up patients were also asked to complete a five-point self-rated scale of Clinical Global Improvement (CGI).

Results Respectively 68.1% and 66.6% patients rated their general health such as “better” or “much better” on the CGI at discharge and at 1-year follow-up. Good outcomes were predicted by the IPQ-R timeline dimension and by low score on the HoNOS and on the HADS-depression. The HoNOS, the IPQ-R and the COPM performance were responsive to change indexed by self-reported CGI.

Conclusion Our data suggest that a specialized multidisciplinary inpatient programme for FNS can provide long-lasting benefits (measured by CGI) in the majority of patients. Although we identified some interesting findings, further studies are needed to better clarify the role of baseline predictors of good outcomes and the responsiveness of psychological and physical scales.

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