Treatment of functional neurological disorder: an umbrella review of systematic reviews and meta-analyses.

BACKGROUND

Functional Neurological Disorder (FND) is among the most common reasons for neurology outpatient referrals, characterized by disabling motor, sensory, speech, and dissociative symptoms. It poses diagnostic and therapeutic challenges, often requiring multidisciplinary management and a biopsychosocial framework.

OBJECTIVE

To perform an umbrella review of systematic reviews and meta-analyses evaluating treatment efficacy across different FND subtypes, stratifying by intervention type, outcome direction, and quality of evidence.

METHODS

We systematically screened and analyzed 17 reviews encompassing psychological therapies, physiotherapy, neuromodulation, multidisciplinary rehabilitation, and pharmacological approaches. Studies were assessed for effect direction, GRADE certainty, and risk of bias across 10 methodological domains.

RESULTS

Cognitive behavioral therapy (CBT) demonstrated consistent benefit for PNES and mixed presentations, particularly when delivered within multidisciplinary frameworks. Physiotherapy showed moderate improvements in functional motor symptoms, while neuromodulation yielded promising but inconsistent results. Hypnosis and suggestion-based treatments provided subjective benefit in select cases, whereas pharmacological interventions were largely used adjunctively to manage psychiatric comorbidities. Risk of bias and heterogeneity in outcome measures limited direct comparisons, and the overall methodological quality varied across studies.

CONCLUSION

FND management appears to benefit most from tailored, multimodal approaches. While CBT and physiotherapy remain foundational, the overall quality of evidence remains moderate at best, highlighting a need for standardized outcome measures and rigorous trial designs to strengthen future practice guidelines.