Update on the diagnosis and management of functional neurological disorders from Jean-Martin Charcot to 2024

• Published in: La revue de medecine interne 2024-12, Vol.45 (12), p.750
• Main Authors: Aubignat, Mickael, Cervellera, Pierre-Andréa
• Format: Article
• Language: fre
• Subjects: Conversion Disorder - diagnosis; Conversion Disorder - history; Conversion Disorder - therapy; France - epidemiology; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Nervous System Diseases - diagnosis; Nervous System Diseases - history; Nervous System Diseases - therapy
• ISSN: 1768-3122; 1768-3122
• DOI: 10.1016/j.revmed.2024.11.006

Functional neurological disorders (FND) represent a major clinical challenge, characterized by neurological symptoms without identifiable organic lesions. Since the initial descriptions by Jean-Martin Charcot in the 19th century, the understanding and management of FND have evolved considerably. This review aims to provide an up-to-date overview of current knowledge on the diagnosis and management of FND, integrating recent advances and multidisciplinary therapeutic approaches. The diagnosis of FND is based on specific positive clinical signs, rather than on the exclusion of other pathologies. Diagnostic criteria have been refined, promoting earlier recognition and better acceptance by patients. Psychiatric comorbidities, stress factors, and traumatic histories are frequently associated with FND, highlighting the importance of a holistic evaluation. The management of FND includes a multimodal approach, combining psychotherapy, physical rehabilitation, and targeted pharmacological interventions. The involvement of emerging technologies such as non-invasive brain stimulation and the use of artificial intelligence tools, opens up new perspectives in patient care. Finally, this review addresses the ongoing challenges related to stigma and the training of healthcare professionals, while proposing avenues for improving the quality of care provided to patients with FND.