REFER TO FND CLINIC:
For questions call NES Clinic Program Manager. Phone: 720-445-5345 Email: Meagan.firstname.lastname@example.org
Place specific order set in Epic (pushing all documents to clinic)
- “AMBULATORY REFERRAL TO AMC NEURO FUNCTIONAL CONVERSION”
Fax a paper referral form (see attached below) to 720-848-2106
- Specify reason for diagnosis: ATTN Dr. Laura Strom – NES Clinic (non-epileptic seizures)
- Specify diagnosis: Non-epileptic seizures (NES)
- Include referring provider name and contact information (in case we need to reach out)
- If you have access to them, please fax over diagnostic EEG report and neurology imaging records
- If you do not have access, it is very helpful for us to know the primary neurologist’s name and location of those records if known
- Fax all relevant behavioral health notes with confirmed diagnoses
- Most importantly, please notify program manager the referral is on its way through email or phone. Since we are all working from home, the fax doesn’t come straight to us.
Video Upload Information:
If the patient has not been diagnosed with an EEG, Dr. Strom will request video uploads of the patient’s seizure, please ask the patient to follow the instructions attached below.
We cannot accept your patient until the above criteria are met
Information for Providers
If you are a provider treating a patient with functional neurological disorder, non-epileptic seizures, please read the following information regarding our treatment and referral processes.
WHO WE TREAT:
- Patients with Non-Epileptic Seizures confirmed by EEG monitoring with video. The video portion is essential as it is used in the treatment of the patient.
- Patients with any insurance type accepted at UCH, including Medicaid
- Patients who are cognitively able to participate
WHAT WE DO:
The Functional Neurological Disorders clinic uses a shared decision making, multi-disciplinary approach using an expert team of neurologists, psychiatrists, physician assistants, nurse practitioners, and social Workers.
All patients begin treatment with a neurology and psychiatry intake.
Our neurologist meets with each patient after reviewing the video EEG to confirm the NES diagnosis and determining whether or not there is concomitant epilepsy. The diagnosis is discussed from the neurological perspective.
Our psychiatrists meet with patients at baseline, three, and six month follow ups. Each patient receives a full psychiatric evaluation including assessment of concomitant psychiatric comorbidities, discussion of their diagnosis from a psychiatric perspective, psychiatric medication review, and determination of appropriateness to participate in group therapy. During the three and six month follow up appointments, our psychiatrists ensure that each patient is receiving the best possible individualized treatment to fit their needs, encouraging and assisting patients to obtain outside ongoing therapy when needed, assuring continuity and consistency of care.
Unless the patient is deemed inappropriate for group by our providers, each patient is offered participation in the psychoeducational 6 week group therapy. This is led by the neurology (assistant practice providers) APPs. The first 5 weeks is dedicated to cognitive behavioral informed psychoeducation based on the proven work of Dr. Curt LaFrance. We encourage all patients to participate in this component of treatment. In this group the following is covered:
- Learn about NES or expand existing knowledge of their illness
- Learn how to identify triggers and stressors
- Engage in exercises challenging dichotomous approaches to problem solving
- Taught acceptance and coping mechanisms to help manage everyday life with NES
- Begin creating support structures
- Learn mindfulness techniques
- Provided various online and community resources to continue therapeutic work after their time with us
The 6th and final week of the psychoeducation group structure is a multi-family session during which each patient brings two family members/loved ones of their choice who are influential in their life and recovery. This group is run by our psychiatrists and APPs using a fishbowl therapy framework to expose and begin treating any problematic family dynamics or provide already healthy families more information and resources for continued support.
All together, the six week group allows for sharing of medically induced trauma that occurs prior to diagnosis with NES including mistreatment by medical professionals, emotional trauma of being told that the events are purposefully faked, or being over sedated by inappropriate medication. This group does not directly address other forms of trauma such as prior emotional, physical, or sexual abuse that are often comorbid. These sessions prepare the patient, if needed and/or appropriate, for that further work in the 12-week psychodynamic group.
Patients who are appropriate for additional treatment will attend our 12 week psychodynamic group therapy led by our psychiatrist and social worker. This group is unstructured, enabling progression in real time through a range of common themes related to current and past life events. The nature of patients NES events is explored for the role the play as a coping mechanism for emotional distress and/or reactivated traumatic memories. Group work focuses on articulating traumatic experiences to change dissociative and avoidant communication patterns. Family communication styles are often readdressed in the 12 week group. Additionally, relationships within the group often shed light on relationships in personal life and can afford opportunity to practice new skills in a safe and therapeutic environment.
DISCHARGE FROM FND CLINIC:
The FND clinic is NOT a chronic care model. A patient’s participation in FND clinic lasts six months on average if all therapy components are appropriate. Due to the high volume of patients with FND and limited resources it is our goal to successfully establish each patient back with their PCP and outside individual therapy at discharge. At discharge our neurologist will connect with each patient’s PCP and ensure all medical records are transferred and the PCP is educated on what the patient needs for continuation of care.
If you are seeing a patient who has participated in our clinic, please reach out to the FND Clinic program manager to discuss the patient’s case specifically. In some cases patients did not complete all of the prescribed treatment.
What our providers say:
Mental Health Monthly #2: Non-Epileptic Seizures (NES)
Mental Health Monthly #8: Trauma-Informed Care
Dr. Randi Libbon