Functional neurological disorder in Saudi Arabia: A retrospective study

To describe the clinical profile of a sample of Saudi patients with Functional Neurological Disorder (FND).

A retrospective chart review of FND patients seen from 2021-2023 at a neuropsychiatry clinic at an academic tertiary care center in Jeddah, Saudi Arabia.

Out of 473 patients seen in the clinic during the review period, 52 (11%) had FND. Mean age was 34 years (standard deviation = 10.7), and 77% were female. Family dispute (39%) was the most reported risk factor, followed by sexual abuse (15%). The most common FND symptoms were nonepileptic seizures (61.5%) and abnormal movements (30.8%). Pain was reported by 57.7% and cognitive symptoms by 36.5%. FND symptoms were frequently attributed to supernatural causes (67.3%). During the last follow-up visit, 53.9% of patients reported FND symptom improvement, whereas 21.2% reported no change, 10.2% reported worsening, and 15% were lost to follow-up. The proportion of patients without symptom improvement was higher among patients with cognitive symptoms (45.5% vs 18% respectively, X₂ = 10.08, df = 3, p = .018). The mean number of visits was highest in patients reporting worsening and the lowest was among patients reporting no change (F = 4.21, p = .017).

The role of family disputes in FND in the Middle East, the role of supernatural concepts in how FND is perceived, and the relatively high rate of subjective improvement within this sample of Saudi FND patients merit further exploration. Cognitive symptoms may be another prognostic indicator. Prospective multicenter studies of those with FND using standardized assessment measures are needed.