Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children’s Hospital

Abstract

Objective: To describe the presenting symptoms and short-term outcomes of children diagnosed with functional neurologic symptom disorder and to compare the demographic and clinical characteristics of children who received neurodiagnostic testing to those who did not. Study Design: Single center, retrospective review of 222 children who presented to the emergency department of a children's hospital, and diagnosed with functional neurologic symptom disorder, between 2010 and 2015. Results: Out of 222 visits (females ¼ 156, African Americans ¼ 130, mean age ¼ 13.9 years), neurodiagnostic tests were performed in 102/222 (46%) visits. The most commonly performed investigations were magnetic resonance imaging (MRI) of brain (n ¼ 37) and electroencephalogram (EEG) (n ¼ 56) and were noted to be unremarkable in all instances. Neurodiagnostic tests were more likely to be performed in patients who (1) were non-African American (54% vs 40%; P ¼ .03), (2) presented with new-onset symptoms (55% vs 31%; P < .01), (3) underwent hospitalization (61% vs 17%; P < .01), and (4) were evaluated by a neurologist (59% vs 9%; P < .01) or a psychiatrist (58% vs 28%; P < .01). Common clinical presentations included seizurelike or strokelike symptoms. Short-term follow-up was possible in 20%, with an alternate diagnosis of syncope, noted in only 1 child. Conclusions: Most children who presented with a functional neurologic symptom disorder in our study were noted to have seizurelike or strokelike presentations and were adolescent females. Caucasians were more likely to undergo neurodiagnostic investigations. Radiologic and neurophysiological tests were more commonly performed when neurology and psychiatry consultations were sought. Such investigations had low diagnostic utility.

Urologic Presentation and Risk Factors in Pediatric Functional Neurological Symptom Disorder: A Case Report

“…With an estimate of 12 new cases per 100,000 per year, FND disproportionately affects women compared to men (at 3:1) but the reported cases for men increases proportionately with age (Bennett et al, 2021). A 2019 study indicates that many pediatric patients were adolescent girls with seizure or stroke like symptoms (Watson et al, 2019). The adolescent age of this male patient in our case demonstrates deviation from these statistics.…”

“…It is important to recognize the additional risk factors that can contribute to a patient's likelihood of developing FND. The identifiable triggers are often not of a catastrophic nature, despite common perception, and are more frequently related to family, school, or relationship conflicts (Watson et al, 2019).…”

“…This patient has a history of alcohol abuse, recreational drug use, sexual abuse, and grief, in addition to maladaptive relationships in the household. While these risk factors may predispose him to FND, the association with chronic urinary retention was unclear (Watson et al, 2019;Bennett et al, 2021). Although research suggests the status of urinary retention as a type of FND is uncertain, studies have also recognized that chronic urinary retention is a possible symptom of the disorder since the 1880's (Bennett et al, 2021).…”

Changing the culture of care for children and adolescents with functional neurological disorder

“… Resources pertaining to costs of FND for use in education and lobbying of administrators, government bodies, and insurance companies FND as a common disorder (approximately 16% of neurology outpatient visits and up to 23% of patients in epilepsy clinics) [43] , [44] . FND and other presentations with functional somatic symptoms are both common and costly [45] , [46] , [47] . Investment in recently developed treatment interventions (including those for functional seizures) is worthwhile because the interventions have good outcomes [48] , [49] , [50] .…”

Socio-demographic characteristics and psychopathological assessment in a sample of 13 paediatric patients with functional neurological disorders: A preliminary report

“…Consequently, the diagnosis is generally easier in younger children and much more complex in adolescents (Grattan-Smith and Dale, 2016). Again, as in the adult sample, studies about paediatric FND presentation (Guerriero et al, 2014), management (De Gusmão, et al, 2014; Watson et al, 2019) and neurobiological correlates (Kozlowska et al, 2017, 2018, 2019) have been conducted; however, little has been reported and quantified through rating scales with respect to the psychopathological features of FND in children and adolescents. This gap reflects the difficulties in the diagnostic approach to FND, especially in the paediatric population.…”