Abstracts

Rationale: Functional Neurological Disorder (FND) presents significant diagnostic and therapeutic challenges in the pediatric population. This study aims to evaluate the outcomes of children diagnosed with FND in a specialized pediatric FND clinic.

Methods: A retrospective quality improvement study was conducted involving 56 pediatric patients diagnosed with FND at a tertiary pediatric clinic from January 2023 to January 2024. Data on demographics, clinical presentations, co-morbid diagnoses, and follow-up outcomes were collected and analyzed. The primary outcome measure was a 5-point Likert scale describing symptom severity (5, daily impairing symptoms; 4, weekly impairing symptoms; 3, monthly impairing symptoms; 2, less than monthly impairing symptoms; 1, symptom free). This measure was determined retrospectively from chart review and defined as severity at symptom onset and severity at last clinical evaluation. FND subtype and co-morbidities were defined by ICD-10 diagnostic codes. Statistical analysis was performed using Wilcoxon rank-sum test. Approval was obtained by institutional IRB.

Results: Of the 56 patients (median age 15 years; 79% female), there were a total of 103 patient encounters. The majority presented with attacks and seizures (n = 36, 64%), followed by mixed symptoms (n=13, 23%) and abnormal movements (n=7, 13%). A co-morbid diagnosis was common (n=38, 68%) with the most common diagnoses being anxiety (n=16, 29%), headache disorder (n=8, 14%), depression (n=5, 9%), and post-traumatic stress disorder (n=4, 7%). 26 patients had subsequent visits from which outcome measures could be evaluated. Median symptom severity score at presentation was 5 and at last clinical evaluation was 3. Median duration of symptoms was 13 months (range 1-60). 35% of patients experienced remission of symptoms (n=9), 39% of patients improved without remission (n=10), 12% of patients worsened (n=3), and 15% of patients were unchanged (n=4). Of patients who had remission of symptoms 78% (7/9) had symptom duration less than or equal to 12 months. There was a significant difference in duration of FND symptoms in those who had remission and those who did not – 7 months and 19 months respectively (p=0.25).


Conclusions: The outcomes in pediatric patients with FND treated in at a dedicated FND clinic are instructive. There is a greater than 50% attrition rate from clinic with the majority of patients failing subsequent follow up. However, 73% of patients had improvement in their symptoms with most patients decreasing from daily to monthly impairing symptoms. Duration of symptoms greater than 12 months is a significant risk factor for non-remission of symptoms.

Funding: None