Pediatric Functional Neurological Disorder: Demographic and Clinical Factors Impacting Care, 2022, Pal et al

[Andy]

Abstract

This is a multicenter retrospective EMR-based chart review of 88 patients aged 3–21 years admitted for evaluation of functional neurologic disorder (FND). We sought to establish characteristics associated with FND, calculate incidence of abnormal neurodiagnostic findings, and determine features associated with variability in workup and treatment. FND patients were 65% female, 40% White, 33% Hispanic, and 88% primarily English speaking with median 13.9 years. We detected variability in management by age, ethnicity, psychiatric comorbidity, and hospital site. Our findings suggest limited utility to CTs in this setting (100% normal) and that workup can be safely informed by physical exam, which predicted abnormal MRI and LP results. We favor screening for adverse childhood experiences in FND patients. Hospitalization may be a rare opportunity for psychiatry contact.

Paywall, https://journals.sagepub.com/doi/10.1177/08830738221113899

 

[Hutan]

We sought to establish characteristics associated with FND

For a study seeking to do this, the abstract is very unrevealing. Of course there were more females, because everyone knows that females are more likely to have FND...

FND patients were 65% female, 40% White, 33% Hispanic, and 88% primarily English speaking with median 13.9 years.

A quick google tells me that 40% white and 33% Hispanic is an unremarkable racial mix for the places the study was done in. The statistics they give us tell us nothing without knowing the demographics for people in this age range who visit the clinics for the full range of ailments. I suppose saying "Aside from gender, the young people diagnosed with FNDs look pretty much like everyone else in terms of demographic characteristics" doesn't sound very ground breaking.

We detected variability in management by age, ethnicity, psychiatric comorbidity, and hospital site.

Variability in management by hospital site suggests that at least someone is just making stuff up.

 

[rvallee]

Variability in management by hospital site suggests that at least someone is just making stuff up.

You find the same thing with Feng Shui specialists. And every alternative medicine out there. Ask 5 "specialists" about a case and you will have at least 5 different opinions. Actually that's pretty common in medicine, and not a coincidence. Pre-breakthrough expertise is significantly less effective. When the textbook is wrong, a training system built entirely on memorizing the textbook is very ineffective, especially when the wrong models in the textbook are held as more real than reality itself.

It's pathetic how they attribute their own failure to the patients. Every. Damn. Time. They fail at this, have no consistency for anything and basically everything is an opinion. All of this is normal considering this is all made-up. But they take their own flaws and actually turn them into positive evidence for them, which is really the height of pseudoscience, they truly turned this art form all the way to 11.

 

[CRG]

How the hell do you evaluate a 3 year old for FND ? Or perhaps more importantly "why would anyone think of doing such a thing ?". And 21 is now the upper bound for paediatrics ?

 

[NelliePledge]

Stanford, California Neurology department