Long-term outcomes of functional neurological disorder in children, 2019, Stone, Forsyth et al

Andy

Andy

Retired committee member
Abstract
Objectives To establish the incidence and long-term outcomes (up to 21 years) of children presenting to a University hospital paediatric neurology service with symptoms due to functional neurological disorder (FND) with particular reference to occurrence of FND or similar symptoms in adulthood.

Methods Retrospective chart review to determine characteristics of the original paediatric FND presentation plus record-linkage with providers of Child and Adolescent Mental Health Services. Chart review of adult medical records for documentation of functional symptoms in adulthood.

Results 124 individuals (56% female) met entry criteria. The most common presentations were seizures (18%), sensory loss (18%) and motor symptoms (16%). Frequency gradually increased with age of onset with an incidence in paediatric neurological services of 6 per 100 000 children under 16. In up to 21 years’ follow-up (median 8.3 years), 114/124 attained their 16th birthdays by the study census date and were thus eligible for inclusion in an analysis of symptom persistence/recurrence in adulthood. 26/114 (23%) showed evidence of FND in adulthood of sufficient significance to be recorded in medical records.

Conclusion Paediatric FND is commoner than previous estimates. Even in this selected population of children reaching specialist paediatric neurology services, a high long-term remission rate is observed.
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Paywall, https://adc.bmj.com/content/early/2019/07/20/archdischild-2018-316519
Sci hub, not available
 
Retrospective chart review
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Yikes. Considering the stuff that is in my chart I would not trust anything that is found in any medical charts on topics like this. This is an extremely poor method of assessing anything since it is unquantifiable and every medical professional has their own interpretation and opinions.

The conclusion of remission rates is purely speculative and most likely misleading considering how useless medicine is with those problems and how it's usually not worth continuing raising those issues, so naturally they "disappear". This is the same thinking behind "a patient who doesn't come back to the same physician is probably because the problem was resolved", it's massively flawed.
 
Hmmm. I know of one young woman who had horrendous experience from age 9 with ME.
Having neurological symptoms she has seen neurologists, but made no progress, other than to be traumatised.

She has recently discovered she is double homogenous for MTHFR , amongst others and is making improvements outwith NHS.

How many others could there be ?
 
If medical records were accurate there might be some point in reading them. My own have so many mistakes or obfuscations or outright lies that they won't tell you anything much of any use at all under any circumstances. I doubt I'm unique in that.

I did read a post on a forum a few years ago where the poster claimed their medical records said they only had one arm, when they quite clearly and obviously had two. This person also claimed their doctor said the error couldn't be deleted. I've often wondered under what circumstances mistakes can be rectified, if ever.
 
I'd like to see the full article when it appears on sci-hub. It's asking a basic question that it would be useful to have a reliable answer to. I wouldn't totally dismiss it getting to see the full writeup. I wouldn't be surprised if it's not terribly helpful, though.
 
ladycatlover said:
Anything that Jon Stone has anything to do with is likely to be a bit, urm, un-useful. He has a one track mind. FND. FND. FND.
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I have never been able to take him and Sharpe seriously since encountering the story from about 2002 of their writing to an American journal to support their American colleagues diagnosis of hysteria, under one of its many names, in the case of a patient who, upon autopsy, was found to have prion disease. I think the argument was that she may have had prion disease, but there was also a functional overlay which confounded the diagnosis.
 
I'd love to know what happened to the other 10 who didn't make it to their 16th birthday. Probably died scared and confused because someone gave them a diagnosis of 'functional neurological disorder' when symptoms first came on.
 
Sid said:
I'd love to know what happened to the other 10 who didn't make it to their 16th birthday. Probably died scared and confused because someone gave them a diagnosis of 'functional neurological disorder' when symptoms first came on.
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I took that to mean they just weren't 16 yet.
 
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