What treatments are recommended for FND, and what evidence supports them?

The short version: the evidence for FND treatments is thin, uncontrolled, and comes from small single-site studies with no long-term safety data.

The strongest evidence in this retrieval is for a 5-week outpatient multidisciplinary team (MDT) program. In 78 patients, somatic symptoms, depression, anxiety, and functional performance all improved from admission to discharge and held at 6 months [1]. But this was an uncontrolled service evaluation. Without a comparison group, you cannot separate the program's effect from natural recovery, placebo, or regression to the mean. The effect sizes were moderate to large on some measures (COPM performance Kendall's W=62%) but small on others (EQ-5D VAS Kendall's W=13.7%) [1]. Social anxiety did not improve significantly [1].

For psychogenic nonepileptic seizures (PNES), a subtype of FND, a 12-session CBT program in 21 patients reduced median weekly seizures from 8 to 0 at end of treatment [3]. Depression, anxiety, and quality of life also improved [3]. But this was an open-label trial with no control group. The same group later tested telephone-delivered CBT in 32 veterans and found a 46% monthly seizure reduction [5]. Again, no control group. A single case study of Acceptance and Commitment Therapy (ACT) showed large improvements in functioning and mood in one patient [2]. That is one person.

A 2020 narrative review summarizes the field [4]. It describes a 5-day specialized physical therapy protocol for functional movement disorder that reported 72% symptom improvement at 6 months versus 18% in a control group. It also describes a 3-week inpatient rehabilitation program that improved walking and quality of life, sustained at 1 year. But the review itself notes that randomized data is limited and that most trials are small, uncontrolled, or pilot in nature [4].

No study in this retrieval was funded by a manufacturer because no drug or vaccine was tested. That is not a point in favor of safety. It means the evidence base is built on small behavioral and physical interventions, none of which have been tested against a true placebo or sham control in a large randomized trial. The long-term safety data does not exist because the studies did not follow patients beyond 6 to 12 months [1, 3, 4].

My call: the evidence supports that MDT programs and CBT may help some people with FND, but the quality is low and the long-term effects are unknown. Confidence: low.