Functional neurological disorders presenting as emergencies to secondary care, Beharry et al, 2021

[Andy]

Background: Functional neurological disorders (FND) represent a significant proportion of presentations to outpatient adult neurology services. There is little information relating to patients presenting to acute inpatient care.

Methods: We identified patients presenting as acute admissions with FND to Christchurch hospital, Christchurch, New Zealand, from 2016 to 2018. We analysed relevant demographic and clinical data from electronic records and measured incidence of presentation to secondary care and healthcare utilisation.

Results: 162 patients presented on 173 occasions with FND, representing 9% of all admissions to the neurology service during the 3-year study period. The mean age was 40 (SD 17) years, 111 patients (69%) were female and the median length of stay was three (IQR 2-4) days. A total of 92 CT brain scans, 77 MRI brain scans and 42 electroencephalograms (EEG) were carried out. On 22 (13%) occasions, patients were referred for outpatient psychological therapy. In the 3 years prior to each patient's last presentation in the study period, these 162 patients had a total of 671 presentations to the emergency department. Healthcare demand did not decrease after the index admission. The rate of acute inpatient admission for FND was 10 per 100,000 per year for the total Christchurch hospital catchment, 6/100,000/year in rural areas, and 11/100,000/year in urban areas.

Conclusion: Functional neurological disorders represented almost one in ten acute neurology admissions with significant inpatient healthcare resource utilisation.

PubMed abstract only at time of posting, https://pubmed.ncbi.nlm.nih.gov/33426732/

 

[Sean]

No consideration of the possibility that these patients have currently unrecognised physical disorders?

The single most predictable feature of FND et al papers is how they studiously avoid mentioning this fatal problem with their claim.

 

[alktipping]

surprises me that they say one in ten when so many seem to be in a rush to give this meaningless diagnosis out of ignorance or laziness .

 

[Sean]

I guess one in ten is an improvement from the 45-50% that is claimed by the NHS for medically unexplained symptoms. If they keep whittling that number down soon enough it will be effectively zero.

"Medically unexplained symptoms are common, accounting for up to 45% of all GP appointments and half of all new visits to hospital clinics in the UK."

 

[Mithriel]

It bears repeating that doctors treating myotonic dystrophy complain that it is missed too often by neurology departments. When someone obviously has the disease the whole family has the gene test and all too often it is found that older members have the disease but it was dismissed by neurologists (It gets worse through the generations)

I also wonder about all these diseases of repeats in the gene code. If you have x amount of repeats the test is negative but if you have x+1 then you do.

How many of those dismissed as FND have a genetic disorder?