El trastorno neurológico funcional: modelos explicativos y aportes de las psicoterapias

Autores/as

DOI:

https://doi.org/10.22379/anc.2099

Palabras clave:

Trastorno Neurológico Funcional, Trastorno de Conversión, Psicoterapia, Diagnóstico, Clasificación, Modelos explicativos

Resumen

Introducción: el trastorno neurológico funcional (TNF) es una condición clínica caracterizada por sín­tomas motores, sensoriales o cognitivos genuinamente experimentados y caracterizados por la pre­sencia de signos clínicos positivos de inconsistencia interna. Se asocia frecuentemente a discapacidad significativa y elevado uso de recursos sanitarios. Esta revisión sintetiza los modelos explicativos actuales y el aporte de psicoterapias con apoyo empírico al tratamiento de esta condición.

Contenido de la revisión: se realizó una revisión clínica narrativa orientada a la práctica clínica, in­tegrando clasificación nosográfica (DSM-5-TR y CIE-11), subtipos clínicos frecuentes y modelos explicativos. Se focalizó específicamente en las intervenciones psicoterapéuticas desarrolladas para el tratamiento del TNF.

Se describieron las distintas presentaciones del TNF y se halló que los modelos explicativos se orga­nizan en factores predisponentes-precipitantes y perpetuantes e incluyen tanto aspectos neurobioló­gicos como procesos cognitivos, conductuales e interpersonales y sociales. En cuanto al tratamiento, se sintetizaron los abordajes con evidencia empírica: modelos basados en la terapia cognitivo-con­ductual, terapias psicodinámicas/interpersonales breves, programas basados en mindfulness/terapias de tercera ola, exposición prolongada (cuando coexiste trastorno de estrés postraumático) y enfo­ques somáticos y familiares en población infanto-juvenil (por ejemplo: terapia de reentrenamiento y control).

Conclusiones: la evidencia apoya un enfoque interdisciplinario y personalizado según fenotipo, co­morbilidades y factores perpetuantes. Se destaca la necesidad de estudios clínicos más robustos con seguimiento a corto y largo plazo.

Biografía del autor/a

María Marta Areco Pico, Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina

Instituto Fleni, Buenos Aires, Argentina

Guido Pablo Korman, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina

 Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina

Referencias bibliográficas

Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-50. https://doi.org/10.1016/s1474-4422(21)00422-1

Marín-Medina DS, Arenas Vargas PA, Arias Botero JC, Gómez Vásquez M, Santos González CA. Trastornos neurológicos funcionales (TNF): unificando el dualismo mente-cerebro. Acta Neurol Colomb. 2024;40(4):e1888. https://doi.org/10.22379/anc.v40i4.1888

Lazzari C, Nikolou-Walker E, Liu LQ, Rabottini M. Psychiatric comorbidities in functional neurological disorders and psychogenic non-epileptic seizures: a systematic review and policy recommendations for improving assessment and treatment. Neuropsychiatr Dis Treat. 2024;20:2313-31. https://doi.org/10.2147/ndt.s491376

Scévola L, Wolfzun C, Sarudiansky M, Areco Pico MM, Ponieman M, Gonzalez Stivala E, et al. Depressive disorders and quality of life in patients with psychogenic nonepileptic seizures and drug resistant epilepsy living in Argentina. Seizure. 2021;92:174-81. https://doi.org/10.1016/j.seizure.2021.09.004

Myers L, Sarudiansky M, Korman G, Baslet G. Using evidence-based psychotherapy to tailor treatment for patients with functional neurological disorders. Epilepsy Behav Rep. 2021;16:100478. https://doi.org/10.1016/j.ebr.2021.100478

Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64. https://doi.org/10.1136/bmj.o64

Gutkin M, McLean L, Brown R, Kanaan RA. Systematic review of psychotherapy for adults with functional neurological disorder. J Neurol Neurosurg Psychiatry. 2020;92:36-44. https://doi.org/10.1136/jnnp-2019-321926

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing; 2022.

Organización Mundial de la Salud. Clasificación Internacional de Enfermedades, 11.a revisión [internet]. OMS; 2019. [citado 2016 en. 21]. Disponible en: https://icd.who.int/es

Stone J. Incongruence in FND: time for retirement. Pract Neurol. 2024;24(2):163-5. https://doi.org/10.1136/pn-2023-003897

Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: Incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav. 2011;20(2):308-11. https://doi.org/10.1016/j.yebeh.2010.10.022

Goldstein LH, Robinson EJ, Reuber M, Chalder T, Callaghan H, Eastwood C, et al. Characteristics of 698 patients with dissociative seizures: a UK multicenter study. Epilepsia. 2019;60(11):2182-93. https://doi.org/10.1111/epi.16350

Lidstone SC, Costa-Parke M, Robinson EJ, Ercoli T, Stone J, FMD GAP Study Group. Functional movement disorder gender, age and phenotype study: a systematic review and individual patient meta-analysis of 4905 cases. J Neurol Neurosurg Psychiatry. 2022;93(6):609-16. https://doi.org/10.1136/jnnp-2021-328462

Raynor G, Baslet G. A historical review of functional neurological disorder and comparison to contemporary models. Epilepsy Behav Rep. 2021;16:100489. https://doi.org/10.1016/j.ebr.2021.100489

Mavroudis I, Kazis D, Kamal FZ, Gurzu IL, Ciobica A, Pădurariu M, et al. Understanding functional neurological disorder: recent insights and diagnostic challenges. Int J Mol Sci. 2024;25(8):4470. https://doi.org/10.3390/ijms25084470

Drane DL, Fani N, Hallett M, Khalsa SS, Perez DL, Roberts NA. A framework for understanding the pathophysiology of functional neurological disorder. CNS Spectr. 2020;26(6):555-61. https://doi.org/10.1017/s1092852920001789

Voon V, Gallea C, Hattori N, Bruno M, Ekanayake V, Hallett M. The involuntary nature of conversion disorder. Neurology. 2010;74(3):223-8. https://doi.org/10.1212/wnl.0b013e3181ca00e9

Aybek S, Nicholson TR, O’Daly O, Zelaya F, Kanaan RA, David AS. Emotion-motion interactions in conversion disorder: an fMRI study. PLoS One. 2015;10(4):e0123273. https://doi.org/10.1371/journal.pone.0123273

Desmurget M, Reilly KT, Richard N, Szathmari A, Mottolese C, Sirigu A. Movement intention after parietal cortex stimulation in humans. Science. 2009;324(5928):811-3. https://doi.org/10.1126/science.1169896

Maurer CW, LaFaver K, Ameli R, Epstein SA, Hallett M, Horovitz SG. Impaired self-agency in functional movement disorders. Neurology. 2016;87(6):564-70. https://doi.org/10.1212/WNL.0000000000002940

Edwards MJ, Adams RA, Brown H, Pareés I, Friston KJ. A Bayesian account of ‘hysteria’. Brain. 2012;135(11):3495-512. https://doi.org/10.1093/brain/aws129

Keynejad RC, Fenby E, Pick S, Moss-Morris R, Hirsch C, Chalder T, et al. Attentional processing and interpretative bias in functional neurological disorder. Psychosom Med. 2020;82(6):586-92. https://doi.org/10.1097/psy.0000000000000821

Marotta A, Fiorio M, Riello M, Demartini B, Tecilla G, Dallocchio C, et al. Attentional avoidance of emotions in functional movement disorders. J Psychosom Res. 2020;133:110100. https://doi.org/10.1016/j.jpsychores.2020.110100

van der Krujis S, Jagannathan SR, Bodde NMG, Besseling RMH, Lazeron RHC, Vonck KEJ, et al. Resting-state networks and dissociation in psychogenic non-epileptic seizures. J Psychiatr Res. 2014;54:126-33. https://doi.org/10.1016/j.jpsychires.2014.03.010

Jungilligens J, Perez DL. Predictive processing and the pathophysiology of functional neurological disorder. Curr Top Behav Neurosci. 2025;74:279-305. https://doi.org/10.1007/7854_2024_473

Carson A, Ludwig L, Welch K. Psychologic theories in functional neurologic disorders. En: Aminoff MJ, Boller F, Swaab DF, editores. Handbook of Clinical Neurology [internet]. Elsevier; 2016. p. 105-20. [citado 2026 en. 21]. Disponible en: https://doi.org/10.1016/b978-0-12-801772-2.00010-2

Bowman ES. Why conversion seizures should be classified as a dissociative disorder. Psychiatr Clin North Am. 2006;29(1):185-211. https://doi.org/10.1016/j.psc.2005.10.003

Nicholson TR, Aybek S, Craig T, Harris T, Wojcik W, David AS, et al. Life events and escape in conversion disorder. Psychol Med. 2016;46(12):2617-26. https://doi.org/10.1017/s0033291716000714

Stone J. Functional neurological symptoms. J R Coll Physicians Edinb. 2011;41(1):38-42. https://doi.org/10.4997/jrcpe.2011.110

Espay AJ, Ries S, Maloney T, Vannest J, Neefus E, Dwivedi AK, et al. Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology. 2019;93(19):e1787-98. https://doi.org/10.1212/wnl.0000000000008442

Breuer J, Freud S. Estudios sobre la histeria. En: Sigmund Freud Obras Completas - Vol II (1893-1895). Argentina: Amorrortu; 1997.

Kanaan RAA, Craig TKJ, Wessely SC, David AS. Imaging repressed memories in motor conversion disorder. Psychosom Med. 2007;69(2):202-5. https://doi.org/10.1097/psy.0b013e31802e4297

Gonsalvez I, Lane CE, Baslet G. Neuropsychiatric treatment in functional neurological disorder: foundations and future. Semin Neurol. 2026;46(2):176-88. https://doi.org/10.1055/a-2786-3694

Reiter JM, Andrews DJ. A neurobehavioral approach for treatment of complex partial epilepsy: efficacy. Seizure. 2000;9(3):198-203. https://doi.org/10.1053/seiz.1999.0374

LaFrance WC, Baird GL, Barry JJ, Blum AS, Frank Webb A, Keitner GI, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures. JAMA Psychiatry. 2014;71(9):997-1005. https://doi.org/10.1001/jamapsychiatry.2014.817

LaFrance WC, Ho WLN, Bhatla A, Baird GL, Altalib HH, Godleski L. Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth. Epilepsia. 2020;61(11):2572-82. https://doi.org/10.1111/epi.16689

Goldstein LH, Robinson EJ, Mellers JDC, Stone J, Carson A, Reuber M, et al. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry. 2020;7(6):491-505. https://doi.org/10.1016/s2215-0366(20)30128-0

LaFrance WC, Wincze JP. Treating nonepileptic seizures: therapist guide. Oxford University Press; 2015. https://doi.org/10.1093/med:psych/9780199307173.001.0001

Goldstein LH, Mellers JD, Landau S, et al. Cognitive behavioural therapy vs standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES): a multicentre randomised controlled trial protocol. BMC Neurol. 2015;15:98. https://doi.org/10.1186/s12883-015-0350-0.

Goldstein LH, Robinson EJ, Chalder T, Reuber M, Medford N, Stone J, et al. Six-month outcomes of the CODES randomised controlled trial of cognitive behavioural therapy for dissociative seizures: a secondary analysis. Seizure. 2022;96:128-36. https://doi.org/10.1016/j.seizure.2022.01.016

Sharma AA, Allendorfer JB, Correia S, Gaston TE, Goodman A, Grayson LE, et al. Neuroplastic changes in patients with functional seizures following neurobehavioral therapy. Neuroimage Clin. 2025;46:103774. https://doi.org/10.1016/j.nicl.2025.103774

Dallocchio C, Tinazzi M, Bombieri F, Arnó N, Erro R. cognitive behavioural therapy and adjunctive physical activity for functional movement disorders (conversion disorder): a pilot, single-blinded, randomized study. Psychother Psychosom. 2016;85(6):381-3. https://doi.org/10.1159/000446660

Popkirov S, Stone J, Holle-Lee D. Treatment of persistent postural-perceptual dizziness (PPPD) and related disorders. Curr Treat Options Neurol. 2018;20(12):50. https://doi.org/10.1007/s11940-018-0535-0

Herdman D, Norton S, Murdin L, Frost K, Pavlou M, Moss-Morris R. The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness. J Neurol. 2022;269(9):4753-63. https://doi.org/10.1007/s00415-022-11107-w

Howlett S, Reuber M. An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures. Psychotherapy. 2009;46(1):125-38. https://doi.org/10.1037/a0015138

Hobson RF. Forms of feeling: the heart of psychotherapy. Routledge; 2013. https://doi.org/10.4324/9780203713693

Mayor R, Howlett S, Grünewald R, Reuber M. Long‐term outcome of brief augmented psychodynamic interpersonal therapy for psychogenic nonepileptic seizures: seizure control and health care utilization. Epilepsia. 2010;51(7):1169-76. https://doi.org/10.1111/j.1528-1167.2010.02656.x

Reuber M, Burness C, Howlett S, Brazier J, Grünewald R. Tailored psychotherapy for patients with functional neurological symptoms: a pilot study. J Psychosom Res. 2007;63(6):625-32. https://doi.org/10.1016/j.jpsychores.2007.06.013

Hinson VK, Weinstein S, Bernard B, Leurgans SE, Goetz CG. Single-blind clinical trial of psychotherapy for treatment of psychogenic movement disorders. Parkinsonism Relat Disord. 2006;12(3):177-80. https://doi.org/10.1016/j.parkreldis.2005.10.006

Kompoliti K, Wilson B, Stebbins G, Bernard B, Hinson V. Immediate vs. delayed treatment of psychogenic movement disorders with short term psychodynamic psychotherapy: randomized clinical trial. Parkinsonism Relat Disord. 2014;20(1):60-3. https://doi.org/10.1016/j.parkreldis.2013.09.018

Korman GP, Garay CJ. El modelo de terapia cognitiva basada en la conciencia plena (mindfulness). Rev Argentina Clin Psicol. 2012;21(1):5-13.

Dahl CJ, Lutz A, Davidson RJ. Reconstructing and deconstructing the self: cognitive mechanisms in meditation practice. Trends Cogn Sci. 2015;19(9):515-23. https://doi.org/10.1016/j.tics.2015.07.001

Korman GP. Terapia cognitiva, ciencia cognitiva y prácticas orientales: la terapia cognitiva basada en la conciencia plena. En: Garay CJ, Korman GP, editores. Innovaciones en los modelos cognitivo-conductuales. Akadia; 2018.

Baslet G, Dworetzky B, Perez DL, Oser M. Treatment of psychogenic nonepileptic seizures. Clin EEG Neurosci. 2015;46(1):54-64. https://doi.org/10.1177/1550059414557025

Baslet G, Ehlert A, Oser M, Dworetzky BA. Mindfulness-based therapy for psychogenic nonepileptic seizures. Epilepsy Behav. 2020;103(pt. A):106534. https://doi.org/10.1016/j.yebeh.2019.106534

Baslet G, Ridlon R, Raynor G, Gonsalvez I, Dworetzky BA. Sustained improvement with mindfulness-based therapy for psychogenic nonepileptic seizures. Epilepsy Behav. 2022;126:108478. https://doi.org/10.1016/j.yebeh.2021.108478

Foa E, Hembree EA, Rothbaum BO, Rauch S. Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences - Therapist Guide. Oxford University Press; 2019. https://doi.org/10.1093/med-psych/9780190926939.001.0001

Myers L, Vaidya-Mathur U, Lancman M. Prolonged exposure therapy for the treatment of patients diagnosed with psychogenic non-epileptic seizures (PNES) and post-traumatic stress disorder (PTSD). Epilepsy Behav. 2017;66:86-92. https://doi.org/10.1016/j.yebeh.2016.10.019

Cope SR, Smith JG, El-Leithy S, Vanzan S, Hogwood P, Golder D, et al. Randomised feasibility study evaluating eye movement desensitisation and reprocessing therapy for functional neurological disorder (MODIFI). J Neurol. 2025;272(8):493. https://doi.org/10.1007/s00415-025-13219-5

Fobian AD, Long DM, Szaflarski JP. Retraining and control therapy for pediatric psychogenic non‐epileptic seizures. Ann Clin Transl Neurol. 2020;7(8):1410-9. https://doi.org/10.1002/acn3.51138

Stager L, Mueller C, Morriss S, Szaflarski JP, Fobian AD. Sense of control, selective attention, cognitive inhibition, and psychosocial outcomes after Retraining and Control Therapy (ReACT) in pediatric functional seizures. Epilepsy Behav. 2023;142:109143. https://doi.org/10.1016/j.yebeh.2023.109143

Watson C, Stager L, Valaiyapathi B, Goodin BR, Szaflarski JP, Fobian AD. Telehealth provision of Retraining and Control Therapy (ReACT) on cognitive and biopsychosocial functioning in pediatric functional neurological disorder. J Psychosom Res. 2025;192:112112. https://doi.org/10.1016/j.jpsychores.2025.112112

Cómo citar

Sarudiansky, M., Areco Pico, M. M., Tenreyro, M. C., & Korman, G. P. (2026). El trastorno neurológico funcional: modelos explicativos y aportes de las psicoterapias. Acta Neurológica Colombiana, 42(3). https://doi.org/10.22379/anc.2099

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16-06-2026
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