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by Dr Kiran Jilani

Consultant Obstetrician

Functional Neurological Disorders and Pregnancy: how do we treat our patients?

Functional Neurological Disorder (FND) is the second most common neurological condition but it is perhaps the most poorly understood. FND represents a  disabling physical condition with limited management options.There is no structured guidance available apart from case studies and small research trials.

The fundamentals of treatment rests in robust multidisciplinary management, pharmacotherapy for symptom treatment and psychological therapies.There is a role of physical rehabilitation in the form of targeted and tailored physiotherapy.

At Liverpool Women's Hospital we have a joint Obstetric Neurology multidisciplinary clinic which is held every month.This clinic is run by Obstetric and Neurology Consultants and we provide specialist care of women with Functional Neurology Disorder. In our experience, these patients can present with dissociative seizures, functional gait and functional weakness.

We engage with these women every 4 weeks and receive support from anaesthetic consultants, physiotherapy and disability adjustment management. In addition they are reviewed in the specialist Perinatal Mental Health clinic at Liverpool Women's and the Functional Neurology clinic at the Walton Centre.

The risks with the functional seizures and weakness is that patient is at risks of trauma and injury and hence the care and support has to be extensive.

In the episode of BBC Two's 'Hospital' aired on 19th March 2020, we follow Tara and her family with a diagnosis of chronic pain and functional weakness. Tara is able to demonstrate how disabling her symptoms are and how her family is affected, and she has provided us with an in depth view of the difficulties an FND patient faces in day to day life.

In our Obstetric Neurology clinic we are currently collecting our data on functional patients. The medical literature provides no research or case reviews of FND  in pregnancy. Together with Dr Burness at the Walton Centre and with patients like Tara, we are actively working towards a retrospective review of FND and pregnancy at Liverpool Women's Hospital so that we are able to share this information and be able to make positive changes in supporting and managing our patients in future as it requires resources. Our experience is that FND worsens in pregnancy which may be able to point towards the psychological and physical strains of pregnancy and its effect on FND.

We hope through this episode we are able to raise awareness and understanding of this complex condition.

18 March 2020

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