Abstract Details

Title Functional Neurological Disorders in Telestroke – Attitudes and Practice Patterns

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-010

Objective This study sought to identify the attitudes, experiences and practice patterns of a large telestroke practice towards functional neurological disorder (FND).

Background FND is commonly identified as a stroke mimic during the in-person evaluation and treatment of patients with acute ischemic stroke. The identification of FND via telestroke presents unique challenges, and FND has not been widely described in the telestroke literature.

Design/Methods A 23-question online anonymous survey was created and distributed to the 77-physician telestroke practice via email. Responses were compiled and analyzed.

Results A total of 30 surveys were completed (39.0%). Seventy percent of physicians would inform the patient of the possibility of FND with half comfortable disclosing this possibility before the full stroke workup was complete. When FND was considered definite, there was an even split (40%) regarding who sometimes/always includes psychiatry versus those who never include psychiatry in the evaluation. Over three-quarters of physicians felt comfortable making the diagnosis of probable FND via telestroke. Nearly 60% of physicians were somewhat-to-very concerned that patients seeking potentially risky treatments (e.g. thrombolysis) represented possible self-harm behavior warranting immediate psychiatric assessment. The most common frustrations in seeing presumed FND patients included economical and clinical resource misallocation and concern for unnecessary risk in patients choosing thrombolysis. Physicians identified with multiple potential biases in treating FND patients including use of specific language or semantics that favor a given response or confirmation, anchor and overconfidence bias. Over 80% of physicians felt that intangible limitations of telestroke modality affected their ability to accurately and confidently diagnose probable FND.

Conclusions The modality of telestroke adds additional challenges to the diagnosis of FND as stroke mimic etiology. Coupled with clinician frustration and comfort levels, approaches vary throughout the practice. Further study of the approach to FND in telestroke is warranted.

Authors/Disclosures
Johanna L. Morton, MD, MS PRESENTER	Dr. Morton has received personal compensation for serving as an employee of SOC Telemed. Dr. Morton has received personal compensation for serving as an employee of The Joint Commission.
Jaime Hatcher-Martin, MD, PhD, FAAN (Synapticure)	Dr. Hatcher-Martin has received personal compensation for serving as an employee of Synapticure. Dr. Hatcher-Martin has received personal compensation for serving as an employee of HD Genetics. Dr. Hatcher-Martin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Science37. Dr. Hatcher-Martin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurocrine. Dr. Hatcher-Martin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Takeda. Dr. Hatcher-Martin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Neurocrine. Dr. Hatcher-Martin has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for npc Parkinson's Disease Journal.
	No disclosure on file
Robert J. Hallock, MD (Access TeleCare)	Dr. Hallock has received personal compensation for serving as an employee of SOC Telemed.

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