Functional neurological disorders in hospitalized children and adolescents: a retrospective cohort study

Functional Neurological Disorders (FNDs) are a frequent condition in childhood and adolescence, but data on hospitalized pediatric populations remain limited. In this study, we conducted a retrospective analysis of 136 pediatric patients (< 18 years) admitted to a tertiary neurological center over 11 years with a confirmed diagnosis of FND. Demographic, clinical history, and neurophysiological data were collected, and patients were classified according to their clinical phenotype. Mean age at symptom onset was 12.5 years, with prepubertal onset observed in 22% of cases. Multiple FNDs were present in 60% of patients. The predominant phenotypes were movement disorders (27%), seizures (27%), weakness (24%), and sensory disorders (20%). Comorbidities were highly prevalent (68%), including chronic headache (46%), neurological diseases (24%), psychiatric conditions (18%), and other systemic disorders (12%). Extensive diagnostic investigations were frequently required to confirm the functional nature of symptoms, particularly in patients with coexisting neurological conditions. FNDs requiring hospitalization constitute a clinically complex population characterized by high disability and frequent neurological comorbidities. In this context, specialized diagnostic evaluations play a crucial role in supporting a positive diagnosis. Despite several limitations of this study, particularly the limited availability of neuropsychological assessments, follow-up data, and treatment information, this cohort represents a complex and clinically relevant population that provides valuable insights into severe pediatric FND. Further prospective studies are needed to better characterize long-term outcomes, identify prognostic factors and potential biomarkers, and optimize multidisciplinary management strategies.