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Published on: February 22, 2020
The outcome of acute functional neurological disorder: a meta-analysis of stroke-mimic presentations
Suhas Simhan1, Vincent Thijs2,3, Sam Mancuso4
1Department of Psychiatry, University of Melbourne, Austin Health, LTB10, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
Objective:
The prognosis of motor functional neurological disorder (FND) is considered poor; however, all data come from chronic cohorts collected by specialists. The aim of this study was to determine the clinical outcome of acute FND, captured as 'stroke-mimics'.
Methods:
A meta-analysis of studies with outcome data on functional stroke mimics. Authors were contacted to provide more information on their FND mimics, including baseline, discharge and follow-up stroke scales. A random effects meta-analysis of proportion of 'good outcome' was the primary measure of interest, with additional descriptive and statistical analysis. 'Good outcome' employed the usual conventions of modified Rankin Score (mRS) or National Institutes of Health Stroke Scale (NIHSS) ≤ 1.
Results:
Eight studies with 79 patients were identified and analysed, all of cohorts undergoing thrombolysis. The mean age at presentation was 49.7 years with a 62% female preponderance, and median NIHSS score of 4. The proportion of patients with mRS or NIHSS ≤ 1 changed significantly from admission to discharge or follow up [from 24 (30%) to 50 (63%), p < 0.001]. Meta-analysis of the synthesized data showed the pooled standardized mean change (SMC) was statistically significant (SMC = - 1.28, [95% CI = -2.25, - 0.30], p = 0.010) indicating good symptomatic outcome for acute FND patients presenting as stroke-mimics. Heterogeneity was large.
Conclusion:
Patients presenting with acute motor FND have good outcome of their presenting symptoms by discharge and at follow-up, following thrombolysis for presumed stroke, in contrast to specialist cohorts. Demographic differences, in addition to the thrombolysis, are possible explanations for these more favourable results.
Insights
Acute motor functional neurological disorder (FND), often mistaken for stroke, shows good recovery after thrombolysis treatment. This contrasts with previous findings from chronic FND cohorts, suggesting timely intervention improves outcomes.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- Functional neurological disorder (FND) prognosis is typically considered poor based on chronic patient cohorts.
- Existing data on FND outcomes primarily originate from specialist clinics, potentially skewing prognosis perceptions.
- Acute FND presentations, often misdiagnosed as stroke, require distinct outcome evaluation.
Purpose of the Study:
- To investigate the clinical outcomes of acute functional neurological disorder (FND) cases presenting as stroke mimics.
- To contrast the prognosis of acute FND with established outcomes from chronic FND cohorts.
- To analyze the effectiveness of thrombolysis in improving outcomes for acute FND patients.
Main Methods:
- A systematic meta-analysis was conducted on studies reporting outcome data for functional stroke mimics.
- Authors provided detailed baseline, discharge, and follow-up stroke scale data for FND patients.
- Random effects meta-analysis assessed the proportion of patients achieving a 'good outcome' (modified Rankin Score or NIH Stroke Scale ≤ 1).
Main Results:
- Eight studies involving 79 patients, all treated with thrombolysis, were analyzed.
- The proportion of patients with a good outcome (mRS/NIHSS ≤ 1) significantly improved from 30% at admission to 63% at discharge/follow-up (p < 0.001).
- The pooled standardized mean change indicated a statistically significant positive outcome (SMC = -1.28, p = 0.010), despite large heterogeneity.
Conclusions:
- Acute motor FND patients presenting as stroke mimics demonstrate favorable outcomes post-thrombolysis by discharge and follow-up.
- These positive results contrast sharply with outcomes reported in specialist-managed chronic FND cohorts.
- Thrombolysis and potential demographic differences may explain the improved prognosis in acute FND stroke mimics.
