The use of hypnotherapy as treatment for functional stroke: A case series from a single center in the UK

 I can't tell if this was done in the same timeframe as spontaneous recovery, if so then you can't know which one to ascribe recovery to.

The use of hypnotherapy as treatment for functional stroke: A case series from a single center in the UK

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Ranjan Sanyal, Marko Raseta, Indira Natarajan, ...

First Published February 27, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/1747493021995590

Article information

  

Abstract

Background

Functional neurological disorder is defined by symptoms not explained by the current model of disease and its pathophysiology. It is found in 8.4% of patients presenting as acute stroke. Treatment is difficult and recurrence rates are high. We introduced hypnotherapy as a therapeutic option in addition to standard stroke unit care.

Methods

This is an observational study of successive patients with functional neurological disorder presenting as acute stroke treated with hypnotherapy between 1 April 2014 and 1 February 2018. The diagnosis of functional neurological disorder was confirmed by clinical examination and computed tomography/magnetic resonance imaging. Hypnosis was delivered by a hypnotherapy trained stroke physician using imagery for induction. A positive response was defined as a National Institutes of Health Stroke score reduction to 0 or by ≥4 points posthypnotherapy. Costs were calculated as therapist time and benefits as reduction in disability/bed days.

Results

Sixty-eight patients (mean age 36.4 years, 52 (76%) females, mean baseline National Institutes of Health Stroke 5.0 (range 1–9)) were included. Two patients (3%) could not be hypnotized. Fifty-eight 58 (85%) responded, 47 (81%) required one treatment session, while 19% needed up to three sessions for symptomatic improvement. No adverse events were observed. Disability (modified Rankin Scale) reduced from a mean of 2.3 to 0.5 resulting in an average cost saving of £1,658 per patient. Most (n = 50, 86%) remained well without recurrence at six-month follow-up.

Conclusions

In this case series, hypnotherapy was associated with rapid and sustained recovery of symptoms. A prospective randomized controlled study is required to confirm the findings and establish generalizability of the results.

Keywords Hypnotherapy, functional stroke, cost-effective, safe intervention

Introduction

Functional neurological disorder (FND) is a term used to describe a condition where the symptoms are not explained by the current disease model and its pathophysiology. Studies from the UK and continental Europe established that one third of the new patients seen in neurology clinics have symptoms that are only partially explained by organic disease.^1–4 In a study of all patients presenting with acute stroke to a hyperacute stroke unit, 8.4% were found to have FNDs. Health and societal costs of FNDs were estimated to be more than £11 million per year.^5,6 The Department of Health England estimates that medically unexplained symptoms cost the broader economy £17.6 billion each year with direct costs to the National Health Service of £3.1 billion, £5.2 billion in productivity loss, and £9.3 billion attributed to reduced quality of life.⁷ Hence, FND is a major problem facing health and social services resulting in loss of productivity, poor quality of life, and a substantial economic burden. Treatment approaches vary. NHS Scotland recommends a stepped care model starting with diagnosis and explanation, followed by brief interventions such as cognitive behavior therapy and self-help, where needed, and a multidisciplinary approach for refractory cases.⁵ A recent review of the management of FNDs in the American Journal of Psychiatry suggests that FND does not fit neatly into either the specialty of psychiatry or neurology and should therefore be addressed by an interdisciplinary approach with collaboration of neurologists and psychiatrists making use of a wide range of treatment approaches including antidepressants, psychotherapy, physical therapy, cognitive behavior therapy, and hypnosis.⁶

Hypnosis is a temporary condition of altered attention in the subject which may be induced by another person and in which a variety of phenomena may appear spontaneously or in response to verbal or other stimuli. These phenomena include alterations in consciousness and memory, increased susceptibility to suggestion, and the production in the subject of responses and ideas unfamiliar to them in their usual state of mind. Furthermore, phenomena such as anaesthesia, paralysis and rigidity of muscles, and vasomotor changes can be produced and removed in the hypnotic state.⁸ To date, only two randomized controlled trials of hypnosis in the treatment of functional symptoms (conversion disorder and somatoform disorder) have been reported.^9,10 Both included patients with chronic symptoms. One, comparing a comprehensive treatment program with and without hypnosis, found no additional benefit,⁹ and the other, comparing hypnosis against waiting list controls, showed better recovery with hypnosis.¹⁰

There is no evidence-based effective therapy for patients presenting acutely with functional stroke symptoms. Hypnosis has been used to treat functional neurological symptoms in a range of neurological presentations. We introduced hypnotherapy as an additional treatment option for patients presenting with functional symptoms¹¹ mimicking acute stroke. A pathway was developed and approved by clinical governance, which included an audit of response rates and complications. In this paper, we report the outcome of the first 68 cases treated.

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