title: Increased pediatric functional neurological symptom disorders after the Boston marathon bombings: a case series.
abstract: BACKGROUND
  Functional neurological symptom disorders are frequently the basis for acute neurological consultation. In children, they are often precipitated by high-frequency everyday stressors. The extent to which a severe traumatic experience may also precipitate functional neurological abnormalities is unknown.
  
  
  METHODS
  For the 2-week period after the Boston Marathon bombings, we prospectively collected data on patients whose presentation suggested a functional neurological symptom disorder. We assessed clinical and demographic variables, duration of symptoms, extent of educational impact, and degree of connection to the Marathon bombing. We contacted all patients at 6 months after presentation to determine the outcome and accuracy of the diagnosis.
  
  
  RESULTS
  In a parallel study, we reported a baseline of 2.6 functional neurological presentations per week in our emergency room. In the week after the Marathon bombings, this frequency tripled. Ninety-one percent of presentations were delayed by 1 week, with onset around the first school day after a city-wide lockdown. Seventy-three percent had a history of a prior psychiatric diagnosis. At the 6 months follow-up, no functional neurological symptom disorder diagnoses were overturned and no new organic diagnosis was made.
  
  
  CONCLUSIONS
  Pediatric functional neurological symptom disorder may be precipitated by both casual and high-intensity stressors. The 3.4-fold increase in incidence after the Boston Marathon bombings and city-wide lockdown demonstrates the marked effect that a community-wide tragedy can have on the mental health of children. Care providers must be aware of functional neurological symptom disorders after stressful community events in vulnerable patient populations, particularly those with prior psychiatric diagnoses.
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Réjean M
authors.initials: RM
authors.lastname: Guerriero
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Pier
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Claudio M
authors.initials: CM
authors.lastname: de Gusmão
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Miya E
authors.initials: ME
authors.lastname: Bernson-Leung
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Kiran P
authors.initials: KP
authors.lastname: Maski
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: David K
authors.initials: DK
authors.lastname: Urion
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Pediatric Movement Disorders Clinic, Massachusetts General Hospital, Boston Massachusetts. Electronic address: jeff.waugh@childrens.harvard.edu.
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Waugh
mesh_terms: D000293:Adolescent; D001900:Boston; D002648:Child; D004190:Disasters; D053834:Explosive Agents; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010372:Pediatrics; D012420:Running
chemical_list: D053834:Explosive Agents
keywords: conversion disorder; functional neurological disorder; somatoform disorder; terrorism