Treatment outcomes in functional neurological disorder: a systematic review and meta-analysis exploring the influence of symptom chronicity
- rajaduttamd
- Jan 8
- 1 min read
Conversion disorder—now termed Functional Neurological Disorder (FND)—has long been viewed through a pessimistic lens, particularly when symptoms persist over time. A major 2025 systematic review and meta-analysis in BMJ Neurology Open challenges that assumption by examining whether symptom chronicity actually limits treatment response. Drawing on 63 studies (27 included in meta-analyses, 885 patients), the authors evaluated outcomes across functional motor disorders, functional/dissociative seizures (PNES/FDS), and mixed presentations, covering psychotherapy, physiotherapy, multidisciplinary rehabilitation, and other interventions FND.
The findings are quietly transformative. While longer symptom duration was associated with modestly smaller gains in motor symptom severity and physical quality of life, it did not eliminate meaningful clinical improvement. Across studies, patients experienced consistent global improvement, better mental health–related quality of life, and—critically for PNES—reductions in seizure frequency, even when symptoms had been present for many years. In functional motor disorders, the average patient still reported mild-to-moderate overall improvement, and mental health gains appeared independent of how long symptoms had existed. These results directly counter the idea that chronic FND is untreatable or refractory.
Taken together, current meta-analytic evidence reframes FND as a treatable, plastic brain–body disorder, rather than a static or degenerative condition. Early diagnosis and intervention do matter—but the data strongly argue against therapeutic nihilism in chronic cases. Patients with long-standing symptoms still benefit from care, especially when treatment targets motor retraining, attention, expectation, and self-agency through physiotherapy and psychotherapy. For clinicians, systems, and policymakers, the message is clear: withholding treatment based on chronicity is not evidence-based, and expanding access to structured FND care is likely to yield real, patient-meaningful gains.
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