title: Functional neurological symptom disorders in a pediatric emergency room: diagnostic accuracy, features, and outcome.
abstract: BACKGROUND
  In children, functional neurological symptom disorders are frequently the basis for presentation for emergency care. Pediatric epidemiological and outcome data remain scarce.
  
  
  OBJECTIVE
  Assess diagnostic accuracy of trainee's first impression in our pediatric emergency room; describe manner of presentation, demographic data, socioeconomic impact, and clinical outcomes, including parental satisfaction.
  
  
  METHODS
  (1) More than 1 year, psychiatry consultations for neurology patients with a functional neurological symptom disorder were retrospectively reviewed. (2) For 3 months, all children whose emergency room presentation suggested the diagnosis were prospectively collected. (3) Three to six months after prospective collection, families completed a structured telephone interview on outcome measures.
  
  
  RESULTS
  Twenty-seven patients were retrospectively assessed; 31 patients were prospectively collected. Trainees' accurately predicted the diagnosis in 93% (retrospective) and 94% (prospective) cohorts. Mixed presentations were most common (usually sensory-motor changes, e.g. weakness and/or paresthesias). Associated stressors were mundane and ubiquitous, rarely severe. Families were substantially affected, reporting mean symptom duration 7.4 (standard error of the mean ± 1.33) weeks, missing 22.4 (standard error of the mean ± 5.47) days of school, and 8.3 (standard error of the mean ± 2.88) of parental workdays (prospective cohort). At follow-up, 78% were symptom free. Parental dissatisfaction was rare, attributed to poor rapport and/or insufficient information conveyed.
  
  
  CONCLUSIONS
  Trainees' clinical impression was accurate in predicting a later diagnosis of functional neurological symptom disorder. Extraordinary life stressors are not required to trigger the disorder in children. Although prognosis is favorable, families incur substantial economic burden and negative educational impact. Improving recognition and appropriately communicating the diagnosis may speed access to treatment and potentially reduce the disability and cost of this disorder.
authors: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Department of Neurology, Pediatric Movement Disorders Clinic, Massachusetts General Hospital, Boston Massachusetts. Electronic address: claudio.degusmao@childrens.harvard.edu.
authors: Claudio M
authors: CM
authors: de Gusmão
authors: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors: Réjean M
authors: RM
authors: Guerriero
authors: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors: Miya Elizabeth
authors: ME
authors: Bernson-Leung
authors: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors: Danielle
authors: D
authors: Pier
authors: Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.
authors: Patricia I
authors: PI
authors: Ibeziako
authors: Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.
authors: Simona
authors: S
authors: Bujoreanu
authors: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors: Kiran P
authors: KP
authors: Maski
authors: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors: David K
authors: DK
authors: Urion
authors: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Department of Neurology, Pediatric Movement Disorders Clinic, Massachusetts General Hospital, Boston Massachusetts.
authors: Jeff L
authors: JL
authors: Waugh
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017281:Cost of Illness; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D010290:Parents; D017060:Patient Satisfaction; D010372:Pediatrics / Q000193:education / Q000592:standards*; D012189:Retrospective Studies; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D055815:Young Adult
keywords: conversion disorder; emergency; functional neurological disorders; medical education; somatoform disorders