Increased pediatric functional neurological symptom disorders after the Boston marathon bombings: a case series
Réjean M Guerriero1, Danielle B Pier1, Claudio M de Gusmão1
1Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Insights
Severe stressors, like community tragedies, can trigger functional neurological symptom disorders in children. These disorders, often linked to prior psychiatric diagnoses, were observed to increase significantly after the Boston Marathon bombings.
Area of Science:
- Neurology
- Child Psychiatry
- Trauma Studies
Background:
- Functional neurological symptom disorders (FNSD) are common reasons for pediatric neurological consultations.
- While everyday stressors can trigger FNSD in children, the impact of severe trauma remains less understood.
- This study investigates the link between a major traumatic event and FNSD in pediatric populations.
Purpose of the Study:
- To assess the incidence of pediatric functional neurological symptom disorders following a large-scale community trauma.
- To examine the characteristics and outcomes of these presentations.
- To understand the role of severe stressors in precipitating FNSD.
Main Methods:
- Prospective data collection for 2 weeks post-Boston Marathon bombings on patients with suspected FNSD.
- Assessment of clinical, demographic, symptom duration, educational impact, and trauma connection.
- 6-month follow-up to verify diagnoses and outcomes.
Main Results:
- The weekly incidence of FNSD presentations tripled in the week following the bombings.
- Most new cases (91%) emerged around the first school day after a city-wide lockdown.
- 73% of affected children had a prior psychiatric diagnosis; no diagnoses were overturned at 6 months.
Conclusions:
- Both everyday and intense stressors can precipitate pediatric FNSD.
- Community-wide tragedies, like the Boston Marathon bombings, significantly impact children's mental health, increasing FNSD incidence.
- Healthcare providers should consider FNSD in children presenting after stressful events, especially those with a history of psychiatric conditions.
Background:
Functional neurological symptom disorders are frequently the basis for acute neurological consultation. In children, they are often precipitated by high-frequency everyday stressors. The extent to which a severe traumatic experience may also precipitate functional neurological abnormalities is unknown.
Methods:
For the 2-week period after the Boston Marathon bombings, we prospectively collected data on patients whose presentation suggested a functional neurological symptom disorder. We assessed clinical and demographic variables, duration of symptoms, extent of educational impact, and degree of connection to the Marathon bombing. We contacted all patients at 6 months after presentation to determine the outcome and accuracy of the diagnosis.
Results:
In a parallel study, we reported a baseline of 2.6 functional neurological presentations per week in our emergency room. In the week after the Marathon bombings, this frequency tripled. Ninety-one percent of presentations were delayed by 1 week, with onset around the first school day after a city-wide lockdown. Seventy-three percent had a history of a prior psychiatric diagnosis. At the 6 months follow-up, no functional neurological symptom disorder diagnoses were overturned and no new organic diagnosis was made.
Conclusions:
Pediatric functional neurological symptom disorder may be precipitated by both casual and high-intensity stressors. The 3.4-fold increase in incidence after the Boston Marathon bombings and city-wide lockdown demonstrates the marked effect that a community-wide tragedy can have on the mental health of children. Care providers must be aware of functional neurological symptom disorders after stressful community events in vulnerable patient populations, particularly those with prior psychiatric diagnoses.
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