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Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Diagnostic Agreement and 1-Year Outcomes in Functional Neurological Disorder Following Neuroscience-Informed
Adriano Mollica1,2, Enoch Ng2, Sricherry Nannapaneni3
1Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Background:
We sought to explore outcomes at 1 year in functional neurological disorder (FND) following a neuroscience-informed education and counseling assessment.
Methods:
Patients with FND were assessed at a quaternary neuropsychiatry clinic in Toronto, Canada, and provided education and counseling to build insight into their FND diagnosis. Patient-determined diagnostic agreement at follow-up was categorized as a binary variable: (i) symptoms attributable primarily to FND or (ii) attributable to another cause (neurological disease or unknown). One-year symptom status was patient-reported on a 7-point scale (-3 to +3), with scores ≥2 defined as meaningful improvement. Return to work/school was assessed as an indicator of global improvement of functional status. Univariate tests screened variables for inclusion in multivariate logistic regression models, which evaluated associations between diagnostic agreement and other outcomes.
Results:
A total of 282 patients with FND were assessed (mean age 38.9 ± 12.0 years; 80.3% female), and of these, 127 had 1-year follow-up data. FND subtypes included functional movement disorder (functional weakness [26.8%], hyperkinetic movement [15.7%]), seizure (15.0%), sensory (16.5%), functional cognitive disorder (7.9%), persistent postural perceptual dizziness (14.2%), and speech/swallowing (3.9%). Diagnostic agreement was significantly associated with symptom improvement (odds ratio [OR] = 3.81, 95% CI: 1.33-11.71, p = 0.015) and global improvement (OR = 5.74, 95% CI: 1.11-37.54, p = 0.047). Psychiatric comorbidity (p = 0.026), childhood trauma (p = 0.015), and psychological triggers (p = 0.013) were associated with diagnostic agreement, while ongoing medical/neurological workup was linked to disagreement (p < 0.001).
Conclusion:
Diagnostic agreement was associated with symptom improvement and return-to-work/school status in FND patients who received a neuroscience-informed education and counseling assessment. However, given the observational design and lack of baseline measurement of diagnostic agreement, the directionality of this relationship cannot be determined.