skip to Cookie NoticeSkip to contents

Your health and safety remain our top priority: Learn about our Safe Care Commitment | Use our Prescreen app before arrival for faster entry | Read the COVID-19 Vaccine FAQs

Header Skipped.

Functional Neurological Disorder (FND) Program

Functional Neurological Disorder (FND)

Functional Neurological Disorder

Functional Neurological Disorder (FND) is the one of the most common diagnoses in a general neurology clinic. It can profoundly impact quality of life and psychosocial functioning in patients, like many neurological diseases. Our group at Brigham and Women’s Hospital (BWH) provides multidisciplinary and compassionate care of the highest quality, guided by evidence-based principles.

We provide state-of-the-start clinical care to patients with FND and develop a diagnosis which is established by a clinician through a thorough examination and evaluation that reveals no structural or electrophysiological abnormality that would explain the symptom. Depending on each case, the evaluation may require laboratory tests, imaging and neurophysiological testing such as electroencephalography, electromyography and nerve conduction testing.

What Functional Neurological Disorder (FND) Program Provides?

Our care includes multidisciplinary clinical assessments and treatment for patients with FND in different settings including outpatient, inpatient epilepsy monitoring unit or other inpatient consultation services. Following a collaborative care model, we work with the patient’s established providers to manage this common and debilitating condition.

Our program requires the referring clinician (or a provider identified as the primary clinician) remain part of the treatment team caring for their patient. Depending on each case, we offer multi-modal short-term outpatient treatment and provide outpatient consultation with recommendations for their community clinicians to deliver treatment.

Our group meets regularly to discuss patients’ clinical progress and can offer consultations to clinicians to help with management of some of their more complex patients with FND. Given how common FND is, we place special emphasis on connecting with referring and other clinicians (general internists, psychiatrists, neurologists, other mental health clinicians) bringing them into our team, to create a sustainable model for care beyond what can be provided within BWH.

The clinical components may include:

  1. An initial clinical assessment by an expert neurologist, physical medicine expert, neuropsychiatrist and/or social worker
  2. A discussion of the diagnosis and treatment plan with the patient and referring provider
  3. A care management component to help ensure treatment recommendations are implemented by the treatment team (either at BWH or closer to the patient)
  4. If appropriate and feasible, multidisciplinary short-term treatment that involves treatment by a dedicated physical therapist, a specialized psychotherapist, follow-up with neurology and neuropsychiatry;
  5. At the end of the treatment, a discussion of long-term needs with appropriate community referrals, if applicable.

Who Can Benefit From Functional Neurological Disorder (FND) Program?

We treat patients with Functional neurological symptoms that may include weakness, cognitive problems, dizziness, seizure-like spells, speech or sensory dysfunction which are not compatible with any recognized neurologic condition. In FND, the brain has a problem in how it communicates (send or receive signals) to the rest of the body and how it integrates other neurological functions. 

Meet the Team

Our team also includes residents, trainees, fellows, and interns from different disciplines who develop clinical skills and have opportunities to participate in existing research projects or receive mentoring for their own research. Our group has been committed to present at national and international conferences (American Neuropsychiatric Association, American Epilepsy Society, Functional Neurological Disorder Society, American Psychiatric Association, American Neurological Association) with the goal of increasing knowledge, awareness and understanding about FND.

Research

Members of our team have completed previous research studies on FND motor and seizure types (PNES) including longitudinal outcomes, mindfulness-based psychotherapy, treatment adherence and motivational interviewing, care management.  These studies were done with the support of grants (including foundations, NIH infrastructure grants) and resulted in publications and presentations at academic conferences. If you are interested in supporting our research, please let us know or contact Virginia Fuller in the Development Office at BWH at 617-424-4329.

We are involved in a variety of research projects; please ask your provider if you are interested in participating in research. Current research interests include:

  • rhythmic auditory stimulation for functional gait disorder
  • Improving education and outcomes for patients with FND

Contact and Locations

For an initial consultation with the Brigham and Women’s FND team, please complete our Intake Questionnaire.  We need the medical records regarding your neurological symptoms, CDs of prior imaging, EEG results especially one that captured your events.  These should be sent for review prior to your appointment. For questions, please call 617-732-7432 or email to fndscheduling@bwh.harvard.edu

Patient Resources

Support Our Work

Thank you for your interest in the Functional Neurological Disorders (FND) Program at Brigham and Women’s Hospital. If you are interested in learning about ways to support our efforts, please let us know. There is much work to be done to help improve the lives of our patients.

For providers/medical professionals

  • Requested Information: pertinent past records, CDs of pertinent imaging, EEG results especially if it captured events, prior neuropsychological testing.

Expectations- It is essential that the referring clinician remain involved in the patient’s care as our goal is to improve the care of the patient which involves supporting and educating the referring team rather than just transferring care. Our model also involves short term treatment, consultation and liaison with one of our experts to treatment/care in the patient’s local community. We believe this provides the greatest chance of improved patient outcome, increased knowledge for all clinicians, and maximizes ability for us to help as many patients with this common and very debilitating.

Clinical Resourses

https://www.fndsociety.org/fnd-education

https://www.epilepsy.com/learn/diagnosis/imitators-epilepsy/psychogenic-nonepileptic-seizures-pnes-cause-diagnosis-and

https://www.ilae.org/journals/epigraph/epigraph-vol-23-issue-2-spring-2021/by-any-other-name-what-to-call-psychogenic-non-epileptic-seizures

LEARN MORE ABOUT BRIGHAM AND WOMEN’S HOSPITAL


For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.

About BWH