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AAN 2026 | Guidance for triaging and treating functional movement disorder

Sarah Lidstone, MD, PhD, Toronto Western Hospital & University of Toronto, Ontario, Canada, discusses the importance of understanding the onset and progression of functional movement disorder and the need for patients to engage in therapy and self-awareness to manage their symptoms. Dr Lidstone highlights that patients often require time to accept their diagnosis and understand their symptoms, including identifying triggers and patterns, which is crucial for developing effective treatment strategies with the help of physiotherapists, psychiatrists, and neurologists. This interview took place at the 78th American Academy of Neurology (AAN) Annual Meeting in Chicago, IL.

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Transcript

Yeah, I think we’ve learned over time through a lot of evidence in terms of studies that have been done, but also just in routine clinical practice that, you know, just because often functional movement disorder begins quite abruptly, it’s often an abrupt onset, that’s not the way people get better. It doesn’t just disappear one day and go away on its own. It often requires work and treatment and a lot of therapy...

Yeah, I think we’ve learned over time through a lot of evidence in terms of studies that have been done, but also just in routine clinical practice that, you know, just because often functional movement disorder begins quite abruptly, it’s often an abrupt onset, that’s not the way people get better. It doesn’t just disappear one day and go away on its own. It often requires work and treatment and a lot of therapy. So we’ve come to understand that not everybody is ready to engage in therapy at the same time. And sometimes people need a little bit of time in order to kind of get used to the diagnosis or understand what’s going on in their bodies. And they need to practice some kind of basic fundamental tips. For example, noticing their symptoms are changing. So when are the symptoms better and when are they worse? What are any triggers if they can notice triggers? And these patterns to understanding their own symptoms is very useful in treatment of FND because the physiotherapist, psychiatrist, and other psychotherapist sometimes, even the neurologist, can understand when are symptoms better, when are they worse, and then what strategies can be implemented to help with that, right? So for example, there’s patients that get attacks of symptoms out of the blue, and they don’t understand their own triggers, but they do know they have a warning that it’s coming. And so in that situation, if they get to understand how that warning shows up in their body, what those symptoms are, they can intervene early with things like grounding techniques to lower the activation of the nervous system to help prevent that attack from happening. So these are things that we can teach our patients to help with the recovery.

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