This study sought to establish demographic and clinical characteristics associated with pediatric functional neurologic disorder (FND), identify the incidence of abnormal neurodiagnostic findings, and determine if characteristics are associated with variability in diagnosis and treatment.

Pediatric FND is common but under-investigated. Patients may undergo ineffective, costly, and/or invasive management.

This is a multicenter retrospective EMR-based chart review of 88 patients aged 3-21 years. We included patients with relevant billing codes, no obvious organic etiology (e.g. infection), and follow up within three months. Patients were excluded for previously diagnosed FND, cerebral palsy, or oncologic/neurodegenerative conditions. We used descriptive statistics and univariate/multivariate analyses.

78% of patients were diagnosed with FND. They were 64.3% female, 38.6% White, 32.9% Hispanic/Latinx, and 87.1% primarily English speaking with median age 13.9 years. Hispanic/Latinx patients underwent more electroencephalography (p=0.02) but no other differences were observed across race, ethnicity, gender, or language. Younger patients were less likely to receive psychiatric care (p<0.01) and more likely to undergo lumbar puncture (p=0.02).  In patients with FND, 20% endorsed personal abuse, but this was not documented in 37.1% of patients. All CTs were normal. Abnormal MRI and LP findings were predicted by neurologic exams (p=0.01, 0.02). Patients at our tertiary-care center were typically seen by psychiatry on admission, while county hospital patients were unlikely to see psychiatry within 3 months (p<0.001).  Patients with chronic psychiatric disease had fewer MRIs and were less likely to be given an alternative diagnosis (p=0.02, 0.03).  

We detected differences with age, ethnicity, psychiatric comorbidity, and hospital site. Our findings suggest limited utility to CTs in this clinical setting and that neurodiagnostic testing can be informed by exam findings. We favor screening for adverse childhood experiences as part of routine evaluation for patients with FND. Admission for FND may be a rare opportunity for psychiatry contact.