Treatment of functional neurological symptoms

INTERVENTION: Intervention group: Educational treatment by neurologists: At the (outpatient) department of Neurology the patient is informed that he or she has functional symptoms. For further treatment these patients are referred to one of the neurologists trained in eductional therapy. This neurologist explains what functional symptoms are and that it is common, that symptoms are reversible and that self‐help is a key part of getting better. The neurologist also explaines what the patient does not have and that the patient is not imaging or putting on the symptoms. The neurologist tries to find out what the thoughts of the patients on the cause of the symptoms are. At the first encounter and the two thereafter the neurologist tries to alter the patients’ cognition of the complaints using simple counselling techniques derived from the studies by Stone et al (2005) and Blankenstein et al (2002), who constructed and tested an abridged reattribution model in Dutch distracted from the work of Goldberg et al (1989) and Gask et al (1989). The neurologists all had the same training and will during the study have regular meetings in which experience with patients is discussed. If the neurologist expects further improvement with physiotherapy, he will refer the patient, but the educational treatment programma by the neurologist remains unchanged. Control group: Standard treatment by a general practitioner. CONDITION: Functional neurological symptoms, Functional somatic symptoms ; ; PRIMARY OUTCOME: The primary outcome is the patient’s level of activities of daily living 12 months after randomisation. Physical disability will be assessed with the AMC linear disability scale (ALDS). The primary outcome will be assessed 3, 6 and 12 months after randomisation. SECONDARY OUTCOME: Secondary outcomes are the physical symptoms score, symptoms of anxiety and depression assessed by the ‘hospital anxiety and depression scale’ (HADS), absence of work, medical consumption (number of visits to physicians, medical treatments, additional examinations, alternative care) and perceived health‐related quality of life (SF‐36). Secondary outcomes will also be assessed at 3, 6 and 12 months. INCLUSION CRITERIA: 1. Tension type headache: Headache without alarming symptoms, not consistent with one of the headache syndromes (migraine, cluster headache or analgesic abuse) and at least one other functional symptom; 2. Back and neck pain: Pain not considered to be caused by spinal pathology (fractures, spondylitis, metastases), myelopathy, radiculopathy, plexopathy or neuropathy and at least one other functional symptom; 3. Pseudo movement disorders: Movement disorders not consistent with one of the known movement disorders; 4. Mainly sensory disturbances: These disturbances cannot be explained by central of peripheral nervous system disorders; 5. Mainly motor disturbances other than movement disorders: These disturbances cannot be explained by central of peripheral nervous system disorders; 6. Pseudo‐epilepsy ¡V atypical seizures without evidence for epilepsy on electroencephalographic investigations.