ätiopathogenese und Behandlung von Funktionellen Neurologischen Störungen mit Fokus auf Funktionelle (Dissoziative) Anfälle

Abstract

Functional neurological symptom disorder (FNSD) is common in clinical practice and carries a high risk of becoming chronic (>50%). DSM-5 and ICD-11 criteria do not require psychological stress in association with neurological symptoms anymore, though recent studies have shown a high prevalence of psychological stress / life events associated FNSD, as well as emotional neglect and trauma in the histories of these patients, in particular those with functional (dissociative) seizures. Structural and functional brain imaging show aberrations in limbic areas and the supplementary motor cortex, though it is still unclear if these represent primary (predisposing) or secondary changes. Interpersonal relationships (including the relationship with the neurologist) have to be considered already in the diagnostic process. Biopsychosocial history taking is the basis for further therapeutic recommendations and management. Positive neurological signs indicative of FNSD are a recent focus of interest. These can accelerate diagnostic decisions considerably. Furthermore, they can be used to demonstrate the functional and potentially reversible pattern of FNSD to the patient. Comorbid psychosomatic issues such as affective disturbances, interpersonal trauma and/or personality disorders influence psychotherapeutic and pharmacological management. Functional therapies such as physiotherapy or speech therapy should be used for the appropriate functional deficits. Management should comprise outpatient as well as inpatient/rehabilitation treatment in the course of the disorder. Early diagnosis and treatment are of paramount importance for prognosis.