Functional Neurological Disorder - a common reason for a neurology inpatient referral, 2023, Ramsay, Stone et al

[Andy]

Background

In 2021 the European Academy of Neurology's training requirements were updated to include Functional Neurological Disorder (FND) as a core topic for the first time. To reinforce these changes, we aimed to understand the proportion of inpatients (in non-neurology settings) who are diagnosed with FND.

Methods
We prospectively collected data on diagnoses made after inpatient ward reviews from neurology trainees at three tertiary neurology centres in Scotland from April-September 2021. We assessed healthcare utilisation data for patients with a diagnosis of FND, epilepsy and epileptic seizures or a neuroinflammatory disorder over the preceding 12 months.

Results
There were 437 inpatient reviews for 424 patients by 13 trainees. The largest single diagnosis was FND (n=80, 18%), followed by epilepsy (n= 64, 14%), primary headache disorder (n=40, 9%) and neuroinflammatory disorders (n = 28, 6%). 48 (11%) had an uncertain diagnosis. Compared to patients with epilepsy or neuroinflammatory disorders, patients with FND had a similar number of admissions (2 vs 2 vs 1), and brain/spine imaging studies (2 vs 1 vs 2).

Conclusions
FND was the most common diagnosis made after a request for an inpatient review by a neurologist from the rest of the hospital in Scotland. Patients with FND have similar health resource needs to other common neurological disorders when they present to hospitals with tertiary neurology services. This data supports FND as a core curriculum topic in neurology training.

Paywall, https://onlinelibrary.wiley.com/doi/10.1111/ene.16003

 

[Andy]

Another one for @dave30th

 

[Sly Saint]

diagnoses made after inpatient ward reviews from neurology trainees

clearly they didn't know what else to diagnose them with so picked the easiest option.

 

[rvallee]

None of this validates whether the diagnoses are correct. All it says is that it's become so easy to be lazy about it that it can easily become the most common diagnosis, regardless of validity. Which is really damning.

 

[dave30th]

Another one for @dave30th

I can't keep up! I'll be curious to see going forward how many of them continue to call it #2 and/or cite the 16% prevalence statistics from the Stone/Carson/Sharpe papers from the Scottish neurology study. I assume they'll just call it common--or now, for inpatient, the most common.

 

[SNT Gatchaman]

An acute inpatient review or consult was defined as a patient admitted to a non-neurology setting in which the responsible team have requested a neurology assessment to aid investigation and management. In practice, this is most commonly inpatient medical wards or accident and emergency.

It would have been useful to detail the services these patients were admitted under, and what, if any, non-neurology diagnoses they had. We simply have "non-neurology setting", most commonly "inpatient medical" and "A&E".

It sounds as if these may have been patients who were referred (GP -> Gen Med) or self-referred (A&E) with neurology symptoms, rather than other medical conditions but it's not clear from the paper. I suspect there's a high bar for a GP to clear for an acute referral to inpatient neurology services, defaulting to Gen Med, who for example would manage acute strokes. (Neurology themselves might tend to only be referred young or otherwise unexpected/unusual strokes.)

From our study FND was, on average, the most common diagnosis made after a request for neurology inpatient review in a non-neurological setting across three different centres in Scotland (18%). FND was more frequently seen than epilepsy (14%), primary headache disorders (9%) and neuroinflammatory conditions (6%). This represents a higher proportion than previously documented for those seen in a neurology outpatient setting*, and higher than several inpatient studies in which FND accounts for 1 in 10 admissions to neurology or stroke units.

*Ref is Who is referred to neurology clinics?—The diagnoses made in 3781 new patients (2010, Clinical Neurology and Neurosurgery)

There were slight differences between study sites. FND was the most common diagnosis in Glasgow (22%) and Aberdeen (20%) respectively, with FND being the second most common diagnosis in Edinburgh (14%) (despite the presence of an FND research group there). Epilepsy or epileptic seizures was the most common diagnosis in Edinburgh (17%).

Perhaps the Edinburgh patients were more likely to already have an FND diagnosis, so less likely to need to be referred for inpatient opinion. Alternatively, is there a difference in the non-neurology diagnoses/admissions between the Glasgow and Edinburgh centres that might correlate with an increased likelihood of an FND diagnosis?

 

[Sean]

From our study FND was, on average, the most common diagnosis made after a request for neurology inpatient review in a non-neurological setting across three different centres in Scotland (18%).

Yes, yes, yes. But is the diagnosis, and all that it entails, actually correct?