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Prognosis in functional and recognised pathophysiological neurological disorders - a shared basis.

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Patients with functional and recognized neurological disorders have similar outcomes and prognosis predictors. Baseline data could not predict individual patient outcomes effectively, highlighting shared challenges in neurological care.

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Area of Science:

  • Neurology
  • Psychosomatic Medicine
  • Clinical Prognostics

Background:

  • Functional neurological disorders (FND) and recognized pathophysiological neurological disorders (RPND) are distinct diagnostic categories.
  • Understanding shared and differing prognostic factors is crucial for patient management and healthcare resource allocation.

Purpose of the Study:

  • To compare self-reported outcomes and clinical trajectories between FND and RPND.
  • To assess the utility of baseline questionnaire data in predicting prognosis for both FND and RPND patients.
  • To identify common and distinct prognostic markers.

Main Methods:

  • A prospective cohort study of 2581 neurology outpatients (716 FND, 1865 RPND).
  • Baseline data included quality of life, symptoms, illness perceptions, and demographics.
  • Logistic regression and deep neural network models predicted 12-month clinical global impression (CGI).

Main Results:

  • Both FND and RPND groups showed similar 12-month outcomes, with 67% and 66% reporting unchanged or worse CGI, respectively.
  • Negative expectation of recovery and disagreement with psychological attribution predicted poorer outcomes in both groups.
  • Receipt of disability benefit predicted worse outcomes in FND but not RPND; deep neural networks showed limited predictive power (AUC 0.67).

Conclusions:

  • Functional and recognized pathophysiological neurological disorders exhibit similar outcomes and clinical trajectories.
  • Shared poor prognostic markers exist, but individual outcome prediction from baseline data was not feasible in this cohort.
  • This suggests a need for integrated approaches to managing patients with diverse neurological conditions.