Treatment engagement and 12-month outcomes after diagnostic communication and individualized treatment planning in patients with functional neurological disorder

Objectives

To evaluate treatment engagement and 12-month outcomes following structured diagnostic communication and individualized treatment planning in inpatients with the most common functional neurological disorder (FND) presentations encountered in epilepsy services and to explore the relationship between treatment engagement and adherence.

Methods

In this prospective cohort study, adult inpatients with a diagnosis of functional/dissociative seizures (FDS) or functional movement disorder (FMD) received a multi-component psychotherapeutic consultation focused on psychoeducation and shared decision-making. Individualized treatment plans were developed collaboratively. Follow-up assessments were conducted over 12 months. Primary outcome was health-related quality of life (SF-36). Secondary outcomes included disorder-specific symptom burden and functional impairment (WSAS). Individual change was assessed using the Reliable Change Index.

Results

Of 55 FND inpatients, 58% (32) were admitted via the emergency department with acute presentations and 42% (23) electively for diagnostic evaluation; 37 were enrolled, while 18/55 (33%) could not be included. Twelve-month follow-up data were available for 25/37 patients (68%). Among completers, treatment engagement rates were high (>80%). Despite high rates of self-reported treatment adherence, no significant group-level improvements were observed. Only 8/25 patients (32%) showed reliable improvement in at least one major outcome domain without deterioration in another.

Significance

Structured diagnostic communication combined with individualized treatment planning was associated with high treatment engagement rates. However, long-term outcomes remain unsatisfactory, suggesting treatment effectiveness as key limiting factor. Limitations include the uncontrolled design and incomplete follow-up. Our findings suggest that therapist specialization and closer integration between neurological and psychotherapeutic care may be important components of FND care.