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Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a
Carla Watson1,2,3, Lalitha Sivaswamy1,2,3, Roshani Agarwal1,4
11 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
Insights
Functional neurologic symptom disorder in children often presents as seizurelike or strokelike symptoms, primarily in adolescent females. Neurodiagnostic testing, while common, showed low diagnostic utility in this patient group.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Neuroscience
Background:
- Functional neurologic symptom disorder (FNSD) is a complex condition affecting children, presenting with diverse neurological symptoms.
- Understanding the diagnostic pathways and outcomes for pediatric FNSD is crucial for effective patient management.
Purpose of the Study:
- To detail the presenting symptoms and short-term outcomes of children diagnosed with FNSD.
- To compare demographic and clinical factors between children who underwent neurodiagnostic testing and those who did not.
Main Methods:
- A retrospective review of 222 children diagnosed with FNSD at a children's hospital emergency department between 2010 and 2015.
- Analysis of neurodiagnostic test utilization, types of tests performed (MRI, EEG), and their results.
- Comparison of characteristics between patients who received testing versus those who did not, including race, symptom onset, hospitalization, and specialist consultations.
Main Results:
- Neurodiagnostic tests were performed in 46% of cases, with brain MRI and EEG being most common, all yielding unremarkable findings.
- Testing was more frequent in non-African American patients, those with new-onset symptoms, hospitalized patients, and those seen by neurologists or psychiatrists.
- Common presentations included seizurelike or strokelike symptoms; short-term follow-up revealed syncope as an alternate diagnosis in only one child.
Conclusions:
- Pediatric FNSD commonly presents as seizurelike or strokelike symptoms in adolescent females.
- Non-African American children and those with new-onset symptoms or specialist involvement were more likely to undergo neurodiagnostic testing.
- Neurodiagnostic investigations in this cohort demonstrated limited diagnostic value for FNSD.
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 = 156, African Americans = 130, mean age = 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 = 37) and electroencephalogram (EEG) (n = 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 = .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.