Disclosures: Susan D. Lis, MD: Nothing to disclose

Case Description: We present a series of five patients admitted to the inpatient rehabilitation unit with diagnoses of conversion disorder, also referred to as functional neurological disorder (FND). Two of the patients presented with hemiparesis, the additional two patient had bilateral lower extremity weakness and the fifth patient had attacks that resembled seizures. The patients were given an intense rehabilitation program including strong support by the rehabilitation psychologist. The physiatrist and treatment team gave a consistent message that the patient would improve. During the course of the program, the patients’ stressors were able to be identified and mitigated. This combined approach of traditional rehabilitation, intense psychologic support, and a positive environment facilitated each of these five patients to make significant improvements and were able to be discharged home with symptom resolution.

Setting: Acute Inpatient Rehabilitation Unit

Patient: 5 patients with FND who were admitted to acute inpatient rehabilitation.

Assessment/Results: All 5 patients improved markedly and were discharged home.

Discussion: Our aim is to broaden the understanding of a prevalent, but poorly understood occurrence in health care, the subjective experience of neurologic dysfunction in the absence of underlying nervous system pathology. This is known as conversion disorder or functional neurologic disorder. The incidence ranges from 4-12 people per 100,000 population. As many as 6% of patients seen in a neurology outpatient setting have FND. There has been promising evidence for the benefit of therapies specifically physical rehabilitation and psychologic intervention. An inpatient rehabilitation unit is an ideal location to effectively and efficiently treat these patients.

Conclusion: Although the prognosis of FND can be quite poor and the disability often persists or even worsens over time, we feel that early diagnosis, positive expectations and intense symptom based therapies can considerably improve the outcome. Our approach of aggressive inpatient rehabilitation has led to excellent outcomes among our patients.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/functional-neurological-disorders-a-series-of-case-studies-to-expand-understanding/