The Inpatient Assessment and Management of Motor Functional Neurological Disorders: An Interdisciplinary Perspective

Abstract Background Motor functional neurologic disorders (FND) — previously termed ‘hysteria′ and later ‘conversion disorder′ — are exceedingly common and frequently encountered in the acute hospital setting. Despite their high prevalence, patients with motor FND can be challenging to accurately diagnose and effectively manage. To date, there is limited guidance on the inpatient approach to the neuropsychiatric evaluation of patients with functional (psychogenic) neurologic symptoms. Objective In this perspective article, the authors outline an inpatient multidisciplinary approach involving neurology, psychiatry, and physical therapy as core components for the assessment and acute inpatient management of motor FND. Discussion A case vignette of a patient with motor FND is presented followed by discussion of general assessment principles. Thereafter, a detailed description of the neurologic and psychiatric assessments is outlined. Delivery of a "rule in" diagnosis is emphasized and specific guidance for what can be accomplished post-diagnosis in the hospital is suggested. We encourage an interdisciplinary approach beginning at the early stages of the diagnostic assessment once an individual is suspected of having motor FND. Conclusions Practical suggestions for the inpatient assessment of motor FND are presented. It is also important to individualize the diagnostic assessment based on the features of each case. Future research should be conducted to test best practices for motor FND management in the acute inpatient hospital setting.