Functional Neurological Symptom Disorders in a Pediatric Emergency Room: Diagnostic Accuracy, Features, and Outcome

Gusmão, Claudio M. de; Guerriero, Réjean M.; Bernson-Leung, Miya E.; Pier, Danielle B.; Ibeziako, Patricia; Bujoreanu, Simona; Maski, Kiran; Urion, David K.; Waugh, Jeff L.

doi:10.1016/j.pediatrneurol.2014.04.009

Cited by 49 publications

(34 citation statements)

References 38 publications

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“…Functional neurologic symptom disorder can often be suspected during the initial interaction and the diagnosis made even by a relatively inexperienced physician with a fair degree of certainty. 20 There is a plethora of literature about clinical clues for conversion disorder in children presenting with neurologic symptoms, a detailed review of which is beyond the scope of the present article. [4][5][6][7][8][9] Table 1 describes some of the classical signs that are useful in this distinction.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…In a group of pediatric patients, all denied his tory of sexual abuse or trauma, and 25% denied even mun dane stressors. 26 A study of adults found no difference in stressful events between patients with PNES, patients with epilepsy or controls, but patients with PNES selfreported greater stress and demonstrated fewer coping skills. 27 This re sult was consistent with a study that found no difference in the number or impact of stressful life events between pa tients with FNSD and controls, but did find that both cortisol (hypothalamic-pituitary-adrenal axis) and αamylase (ad renergic axis) levels were higher in patients with FNSD.…”

Section: Trauma/psychiatric Symptomsmentioning

confidence: 98%

“…Traditionally, secondary gain has been de scribed as an etiological factor for FNSD from a psycho dynamic perspective, serving as an unconscious attempt to escape unwanted psychological distress. 79 The concept of secondary gain as a causal mechanism is contradicted by the absence of stressors before the onset of FNSD in many patients, 26,27 but there is evidence that it may reinforce symp toms or provide a disincentive for symptom resolution in some patients. 74 It has been suggested that PNES are main tained by operant conditioning through both positive and negative reinforcement, such as the release from stress associ ated with employment or increased attention from family or friends, 80,81 or the receipt of disability benefits.…”

Section: Secondary Gainmentioning

confidence: 99%

A review of functional neurological symptom disorder etiology and the integrated etiological summary model

Fobian

Elliott

2019

jpn

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Functional neurological symptom disorder (FNSD) is characterized by neurological symptoms that are unexplained by other traditional neurological or medical conditions. Both physicians and patients have limited understanding of FNSD, which is often explained as a physical manifestation of psychological distress. Recently, diagnostic criteria have shifted from requiring a preceding stressor to relying on positive symptoms. Given this shift, we have provided a review of the etiology of FNSD. Predisposing factors include trauma or psychi atric symptoms, somatic symptoms, illness exposure, symptom monitoring and neurobiological factors. Neurobiological research has indicated that patients with FNSD have a decreased sense of agency and abnormal attentional focus on the affected area, both of which are modulated by beliefs and expectations about illness. Sick role and secondary gain may reinforce and maintain FNSD. The integrated etiological summary model combines research from various fields and other recent etiological models to represent the current understanding of FNSD etiology. It discusses a potential causal mechanism and informs future research and treatment.

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“…Prognosis in adult FND is guarded, with remission rates for motor and seizure symptoms of 21% and 40%, respectively9. Corresponding outcome data in paediatric FND are limited although short-term outcome appears reasonably favourable 7 10 11. Reported symptom freedom rates after non-epileptic seizures in children vary widely from 23% to 72% 12.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of functional neurological disorder in children

et al. 2019

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ObjectivesTo establish the incidence and long-term outcomes (up to 21 years) of children presenting to a University hospital paediatric neurology service with symptoms due to functional neurological disorder (FND) with particular reference to occurrence of FND or similar symptoms in adulthood.MethodsRetrospective chart review to determine characteristics of the original paediatric FND presentation plus record-linkage with providers of Child and Adolescent Mental Health Services. Chart review of adult medical records for documentation of functional symptoms in adulthood.Results124 individuals (56% female) met entry criteria. The most common presentations were seizures (18%), sensory loss (18%) and motor symptoms (16%). Frequency gradually increased with age of onset with an incidence in paediatric neurological services of 6 per 100 000 children under 16. In up to 21 years’ follow-up (median 8.3 years), 114/124 attained their 16th birthdays by the study census date and were thus eligible for inclusion in an analysis of symptom persistence/recurrence in adulthood. 26/114 (23%) showed evidence of FND in adulthood of sufficient significance to be recorded in medical records.ConclusionPaediatric FND is commoner than previous estimates. Even in this selected population of children reaching specialist paediatric neurology services, a high long-term remission rate is observed.

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Functional Neurological Symptom Disorders in a Pediatric Emergency Room: Diagnostic Accuracy, Features, and Outcome

Cited by 49 publications

References 38 publications

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

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

A review of functional neurological symptom disorder etiology and the integrated etiological summary model

Long-term outcomes of functional neurological disorder in children

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