Functional Neurological Disorder Management in a Pediatric Hospital: A Retrospective Chart Review

Functional neurological disorder (FND) is a complex, multinetwork brain disorder that is characterized by the presence of a broad range of neurological symptoms in the absence of neurological disease or damage. For pediatric patients requiring an in-patient stay, misdiagnosis, lack of provider consistency and diagnostic education, frequent testing and work-up, and invasive procedures are often reported. This review will characterize the population, identify current state for receiving diagnosis, detect variability in service delivery, and provide information to evaluate use of resources.

This retrospective chart review examined electronic medical records (EMRs) of 59 patients at a pediatric teaching hospital who were admitted following a visit to the emergency department. Records were compiled by the rehabilitation department with inclusion criteria as having a documented diagnosis of FND or as having a similar functional movement related diagnosis such as chorea, panic disorder, and psychogenic nonepileptic seizure (PNES). Extracted data included the following: demographics, patient characteristics, admission characteristics and experience, and discharge recommendations.

Fifty-nine charts were initially reviewed with 57 meeting inclusion criteria. The subjects in this study had a mean age of 13.7 years (SD: 6.33) and 80.7% were female. The most commonly reported psychiatric diagnoses included anxiety (66.7%), ADHD (29.6%), and depression (22.2%). The most commonly reported FND symptoms at admission were weakness (47.4%), gait instability (28.1%), sensory disturbances (26.3%), and tremor (19.1%). Physical therapy consultations were the most frequently performed (66.7%), followed by occupational therapy (52.6%), psychiatry (38.6%), and psychology (5.3%). No interdisciplinary care conferences were performed. The mean length of stay was 5.13 days (SD: 4.45 days). Readmission rate after 30 days was 16.5%.

This retrospective EMR review identifies opportunities to improve care for pediatric FND, including reducing unnecessary imaging, testing, and readmissions through strengthened provider, patient, and family education. Findings also highlight inconsistent referrals to physical therapy, occupational therapy, and mental health services. Addressing these gaps may enhance patient experience, support more coordinated interdisciplinary care, and reduce healthcare utilization for this under-recognized population.