Intramuscular Trifluoperazine versus Normal Saline for Rapid Symptom Relief in Acute Functional Neurological Disorder: A Prospective Emergency Department Cohort

Background: Functional neurological disorder (FND), formerly known as conversion disorder, is common in emergency departments (ED). Its treatment with short-acting drugs for quick symptom relief is unclear. This study compared intramuscular Trifluoperazine (TFP) to intravenous normal saline (NS) for rapid symptom resolution in acute FND. Methods: We conducted a prospective cohort study at Khatam Al-Anbia Hospital, Zahedan, Iran, from January to December 2023 (ethics IR.ZAUMS.REC.1401.338). Adults diagnosed with FND per DSM-5, with supporting clinical signs, were assigned to receive either 1 mg intramuscular TFP or 500 mL IV NS. All received explanations and de-escalation. Symptoms were recorded at baseline and 15-60 minutes later. The primary outcome was symptom resolution within 60 minutes. Analysis used Cochran’s Q test for within-group changes and χ² or Fisher’s exact tests for between-group differences, significance set at 0.05. Results: Of 80 enrolled patients, 79 were analyzed (39 TFP, 40 NS). Baseline characteristics were similar; non-communication was common. Both groups showed rapid symptom relief. By 60 minutes, 94.9% in the TFP group and 100% in the NS group had symptom resolution (p = 0.241). Symptoms like crying, weakness, and PNES resolved quickly in both groups, with no significant differences at any 15-minute checkpoint. Mild adverse events included transient sleepiness in 3 TFP patients (7.7%) and 1 NS patient (2.5%), and a headache in one patient. No extrapyramidal symptoms or arrhythmias were observed. Conclusions: In cases of acute FND presenting in the emergency department, treatment with Trifluoperazine and normal saline appeared to provide similar relief of symptoms, with few adverse effects observed. These results indicate that factors beyond specific medications may significantly contribute to early symptom improvement. Implementing structured emergency department protocols that emphasize positive-sign diagnosis, de-escalation techniques, and simple supportive measures could be effective in improving patient outcomes.