TY - JOUR
T1 - Functional Neurologic Symptom Disorder in Children
T2 - Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children’s Hospital
AU - Watson, Carla
AU - Sivaswamy, Lalitha
AU - Agarwal, Roshani
AU - Du, Wei
AU - Agarwal, Rajkumar
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Objective: To describe the presenting symptoms and short-term outcomes of children diagnosed with functional neurologic symptom disorder and to compare the demographic and clinical characteristics of children who received neurodiagnostic testing to those who did not. Study Design: Single center, retrospective review of 222 children who presented to the emergency department of a children’s hospital, and diagnosed with functional neurologic symptom disorder, between 2010 and 2015. Results: Out of 222 visits (females = 156, African Americans = 130, mean age = 13.9 years), neurodiagnostic tests were performed in 102/222 (46%) visits. The most commonly performed investigations were magnetic resonance imaging (MRI) of brain (n = 37) and electroencephalogram (EEG) (n = 56) and were noted to be unremarkable in all instances. Neurodiagnostic tests were more likely to be performed in patients who (1) were non–African American (54% vs 40%; P =.03), (2) presented with new-onset symptoms (55% vs 31%; P <.01), (3) underwent hospitalization (61% vs 17%; P <.01), and (4) were evaluated by a neurologist (59% vs 9%; P <.01) or a psychiatrist (58% vs 28%; P <.01). Common clinical presentations included seizurelike or strokelike symptoms. Short-term follow-up was possible in 20%, with an alternate diagnosis of syncope, noted in only 1 child. Conclusions: Most children who presented with a functional neurologic symptom disorder in our study were noted to have seizurelike or strokelike presentations and were adolescent females. Caucasians were more likely to undergo neurodiagnostic investigations. Radiologic and neurophysiological tests were more commonly performed when neurology and psychiatry consultations were sought. Such investigations had low diagnostic utility.
AB - Objective: To describe the presenting symptoms and short-term outcomes of children diagnosed with functional neurologic symptom disorder and to compare the demographic and clinical characteristics of children who received neurodiagnostic testing to those who did not. Study Design: Single center, retrospective review of 222 children who presented to the emergency department of a children’s hospital, and diagnosed with functional neurologic symptom disorder, between 2010 and 2015. Results: Out of 222 visits (females = 156, African Americans = 130, mean age = 13.9 years), neurodiagnostic tests were performed in 102/222 (46%) visits. The most commonly performed investigations were magnetic resonance imaging (MRI) of brain (n = 37) and electroencephalogram (EEG) (n = 56) and were noted to be unremarkable in all instances. Neurodiagnostic tests were more likely to be performed in patients who (1) were non–African American (54% vs 40%; P =.03), (2) presented with new-onset symptoms (55% vs 31%; P <.01), (3) underwent hospitalization (61% vs 17%; P <.01), and (4) were evaluated by a neurologist (59% vs 9%; P <.01) or a psychiatrist (58% vs 28%; P <.01). Common clinical presentations included seizurelike or strokelike symptoms. Short-term follow-up was possible in 20%, with an alternate diagnosis of syncope, noted in only 1 child. Conclusions: Most children who presented with a functional neurologic symptom disorder in our study were noted to have seizurelike or strokelike presentations and were adolescent females. Caucasians were more likely to undergo neurodiagnostic investigations. Radiologic and neurophysiological tests were more commonly performed when neurology and psychiatry consultations were sought. Such investigations had low diagnostic utility.
KW - astasia-abasia
KW - conversion disorder
KW - pseudoseizure
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85062461023&partnerID=8YFLogxK
U2 - 10.1177/0883073819830193
DO - 10.1177/0883073819830193
M3 - Article
C2 - 30819032
AN - SCOPUS:85062461023
VL - 34
SP - 325
EP - 331
JO - Journal of Child Neurology
JF - Journal of Child Neurology
SN - 0883-0738
IS - 6
ER -