Psychiatric and personality factors in pediatric functional seizures: A prospective case-control study

Stager, Lindsay; Morriss, Skylar; Szaflarski, Jerzy P.; Fobian, Aaron D.

doi:10.1016/j.seizure.2022.04.006

Cited by 8 publications

(5 citation statements)

References 49 publications

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“…All these clinicians and their teams have contributed to recent advances in theory, best-practice guidelines, and evaluation of treatment outcomes, thereby providing direction for clinicians around the world (see Supplemental Text Box 2, http://links.lww.com/HRP/A210). 10,11,15,20,25,37,40,43,58,59,74,80,81,92,108–128 Through collaborative efforts, these teams have also worked hard to highlight that the pressing need to develop an FND-informed culture of care that takes into account recent advances in our understanding and clinical care of children and adolescents with FND 26 …”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Kozlowska

Chudleigh

Savage

et al. 2023

Harv Rev Psychiatry

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Learning objectives:• Develop and implement treatment plans for children and adolescents with functional neurological disorder (FND) • Outline a plan to increase awareness and standardize the care for patients with FND using evidence-based interventions Abstract: Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however-and worldwide-FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real ("organic") disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children's Hospital at Westmead in Sydney, Australia-run by a consultation-liaison team-has delivered inpatient care to hundreds of patients with FND and outpatient care to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND. Our aim is to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings.

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Section: Discussionmentioning

confidence: 99%

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Kozlowska

Chudleigh

Savage

et al. 2023

Harv Rev Psychiatry

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“…13 Compared with demographically matched controls, however, emotional and personality variables have been found to be generally similar. 14 The rates of trauma in the pediatric FND population are roughly equivalent to the general population. The majority of children with FND have common life stressors that include school difficulties or peer conflict.…”

Section: Functional Neurologic Disordersmentioning

confidence: 99%

A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic

Wilkinson-Smith,

Lerario,

Klindt

et al. 2023

J Child Neurol

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Youth who identify as transgender and gender nonconforming (TGNC) are at increased risk of anxiety, depression, bullying, and loss of social and family support. These factors may increase the risk of developing functional neurologic disorder (FND). If the risk of FND is increased in TGNC youth, then identifying which youth are at increased risk, and the particular times when risk is increased, may allow for earlier diagnosis and treatment of FND. Better awareness of functional symptoms among clinicians who care for TGNC youth may prevent disruption of gender-affirming care if FND symptoms emerge. Patients diagnosed with FND who are TGNC may require different forms of intervention than other youth with FND. We present 4 cases from our multidisciplinary pediatric FND program of TGNC youth who developed FND. In all individuals for whom follow-up information was available, access to gender-affirming health care was associated with marked improvement or resolution of FND symptoms.

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“…Overall, patients with functional neurological disorder (FND) report decreased quality of life, similar to that of other neurological disorders. They spend significant time seeking an explanation and relief from their symptoms, often with little improvement in symptoms ( 6 – 9 ). Untreated FND symptoms can lead to alterations in ability and functional status, in addition to complicating secondary medical problems.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have examined neuroimaging, other objective assessments, and neuropsychological and biopsychosocial mechanisms ( 16 , 17 , 18 ). Predisposing factors include a history of illness or physical injury in self or family members, increased bodily focus, other illness exposure, decreased sense of agency, and trauma (in adults but not children) or psychiatric symptoms ( 19 , 20 , 21 , 9 ). FND presents unique diagnostic and treatment challenges with an equally debilitating impact on quality of life.…”

Section: Introductionmentioning

confidence: 99%

Optimizing outcomes when treating functional neurological disorder in acute care settings: case reports depicting the value of diagnostic precision and timely and appropriate psychological interventions using an interdisciplinary framework

Greenfield,

Fobian,

Fargason

et al. 2024

Front. Psychiatry

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IntroductionUnexplained physical signs and symptoms represent a significant portion of patient presentations in acute care settings. Even in cases where a patient presents with a known medical condition, functional or somatic symptoms may complicate the diagnostic and treatment processes and prognostic outcome. One umbrella category for neurologically related somatic symptoms, functional neurological disorder (FND), presents as involuntary neurological symptoms incompatible with another medical condition. Symptoms may include weakness and/or paralysis, movement disorders, non-epileptic seizures, speech or visual impairment, swallowing difficulty, sensory disturbances, or cognitive symptoms (1). While FND presents as neuropsychiatric, providers commonly report feeling hesitant to diagnose these disorders. Inexperience or lack of appropriate education on relevant research regarding evidence-based practices or standard of practice (SOP) may result in over- or underperforming diagnostic workups and consultations, utilizing inappropriate medications, and failing to offer evidence-based psychological interventions. Being mindful of these challenges when treating patients presenting with functional symptoms in acute care settings can help to support and protect the patients and care team and appropriately control healthcare costs.MethodsThe University of Alabama at Birmingham Medical Center identified cases representing categories of quality and safety problems that arise in treating FND in acute care settings. Patients signed a consent form to participate in the case report. The case information for each was presented without identifying information.DiscussionThe cases highlight potential challenges when caring for patients presenting with FND in acute care settings. The challenges covered include over- or underutilization of diagnostic workups and consultation, over- or underutilization of psychopharmacological medications, and over- or undertreating a medical condition when a functional symptom is present. In each case, these lapses and errors caused the patient distress, additional treatments, care delays, and delayed symptom remission. Additionally, these challenges have direct and indirect fiscal costs, which can be mitigated with the appropriate education and training, resources, and protocols. Hospitals can benefit from system-wide SOP to improve the identification and management of FND to prevent harm to patients. An SOP commonly presents to specific specialties and ensures the appropriate diagnostic workup, consultations, and timely evidence-based interventions.

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Psychiatric and personality factors in pediatric functional seizures: A prospective case-control study

Cited by 8 publications

References 49 publications

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic

Optimizing outcomes when treating functional neurological disorder in acute care settings: case reports depicting the value of diagnostic precision and timely and appropriate psychological interventions using an interdisciplinary framework

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