as an individual’s ability to process sensory information both within himself or herself as
well as in the external environment to adapt and interact effectively in their daily life.
33
Individuals require intact sensory modulation to respond to sensory stimuli with an
appropriate behavioral response. Impaired sensory modulation can occur when sensory
stimuli do not invoke a specific graded behavioral response, leading to an array of
maladaptive emotional responses, poor learning, and decreased cognitive performance.
For example, many individuals with FND will complain of hypersensitivity to sounds,
moving targets, and crowded environments, and have limited coping strategies to combat
their sensitivity.
32
Sensory-based interventions can thus aid in improving sensory
processing, body awareness, and emotional regulation, as well as promoting normal
movement patterns.
30
Moreover, occupational therapists can work with patients to
implement specific interventions that can successfully modulate sensory information
during daily activities as well as incorporate sensory tools and strategies that a patient can
use when they are symptomatic or are experiencing early warning symptoms of a
psychogenic nonepileptic seizure. These tools and strategies can lead to improved
participation in daily activities and responsibilities and help facilitate patient control over
their symptoms.
• Speech-Language Pathologists (SLP) – Functional Speech Disorder (FSD) is reportedly
seen in up to 50% of patients diagnosed with FND.
34, 35
While clinical features can range
widely, patients with FSD may present with disfluency, stuttering, foreign accent
syndrome, childlike speech, and inconsistent hypernasality, all in the absence of any
anatomical lesion or aphasia.
35, 36
In addition, patients diagnosed with FND may present
with swallowing, language, and cognitive disorders, which also fall under the scope of
SLP practice. Speech-Language Pathologists can work with patients to increase their self-
awareness of their speech impairments, modify their speech output, and support
carryover across various communication settings.
• Psychiatrists/Psychologists – When patients present with psychogenic nonepileptic
seizures (PNES), it is essential that a trained neuropsychiatrist work with them to address
patient control over their seizures. As mentioned above, patients with FND are generally
more likely to have a psychiatric comorbidity when compared to the general population
and may also benefit from specialized psychiatric treatment.
37, 38
Different approaches to
treating patients with PNES have been used with good results, including Cognitive
Behavioral Therapy (CBT), CBT-based self-guided help via workbooks, psychodynamic
therapy, hypnosis, and eye movement desensitization and reprocessing (EMRD).
39
In a
recent RCT of 66 patients with dissociative seizures, it was shown that CBT plus
standard medical care (SMC) was superior to SMC alone.
40
Specific intervention
approaches mentioned in the study include intervening when patients began to exhibit
warning signs indicative of a future seizure, reducing certain avoidance patterns, and
helping address maladaptive thoughts and behavior patterns related to patient’s self-
esteem, well-being, and ability to control their seizures. Of note, anti-epileptic drugs are
not typically given to treat PNES, and some studies have instead observed a harmful