Long-term outcomes of functional neurological disorder in children

Abstract

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.

One-year follow-up of treatment outcomes and patient opinions of Retraining and Control Therapy (ReACT) for pediatric functional seizures

“…Research suggests children with FND have a 77% rate of remission in adulthood [3] . However, duration of symptoms is associated with prognosis [8] , [9] , and prolonged symptoms of FS during childhood likely have negative long-term psychosocial effects [25] , making prompt resolution of FS critical to children’s long-term wellbeing.…”

“…Functional seizures (FS; also known as psychogenic nonepileptic seizures or PNES) are a type of functional neurological disorder (FND) in which patients experience seizure-like symptoms that are not associated with epileptiform activity [1] . About one in five patients in seizure clinics are diagnosed with FS [2] , and in children under 16, the incidence of FND in pediatric neurological services is at least 6 per 100,000x [3] .…”

How to Recognize and Manage Psychosomatic Pain in the Pediatric Emergency Department

“…When unrecognized and untreated, SSD could be extraordinarily disabling and might lead to a progressive loss of life and social opportunities for intellectual growth. It may result in a poor adulthood outcome, leading to a permanent functional disability (20,21). Therefore, the ED setting can represent a unique window of opportunity to identify and support these patients.…”

Mind the gap: integrating physical and mental healthcare for children with functional symptoms

“…Though published studies have revealed the importance of recognising and treating functional symptoms in adults, the literature in children is sparse. Raper and colleagues in this issue add significantly to our knowledge by reporting on a 20-year experience, in their centre, of children with functional neurological disorder (FND) 1. FND, also known as conversion disorder, refers to a spectrum of neurological symptoms which have no established neurological cause and are assumed psychological in origin.…”