1
|
Barak S, Landa J, Eisenstein E, Gerner M, Ravid Vulkan T, Neeman-Verblun E, Silberg T. Agreement and disagreement in pediatric functional neurological symptom disorders: Comparing patient reported outcome measures (PROMs) and clinician assessments. Comput Struct Biotechnol J 2024; 24:350-361. [PMID: 38741721 PMCID: PMC11089279 DOI: 10.1016/j.csbj.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Youth with functional neurological symptom disorder (FNSD) often perceive themselves as having limited capabilities, which may not align with clinical evaluations. This study assessed the disparities between clinician evaluations and patient-reported outcome measures (PROMs) regarding pain, motor function, and learning difficulties in youth with FNSD. Sixty-two youths with FNSD participated in this study, all of whom reported experiencing pain, motor problems, and/or learning difficulties. Clinicians also assessed these domains, resulting in a two-by-two categorization matrix: (1) agreement: child and clinician report "problems"; (2) agreement: child and clinician report "no problems"; (3) disagreement: child reports "problems" while the clinician does not; and (4) disagreement: clinician reports "problems" while the child does not. Agreement/disagreement differences were analyzed. No significant differences in prevalence were observed between the evaluators regarding pain (clinician-85%, child-88%), motor (clinician-98%, child-95%), or learning problems (clinician-69%, child-61%). More than 80% of the children and clinicians report pain and motor disorders. Instances in which children and clinicians reported learning problems (40.3%) exceeded cases in which both reported no problems (9.6%) or only the child reported problems (20.9%). Overall, the agreement between pain and motor function assessments was high (>90%), whereas that concerning learning difficulties was moderate (49.9%). Disagreement in pain/motor assessments was minimal (<5%), whereas for learning difficulties, disagreement rates were high (>20%). In conclusion, a significant concordance exists between PROMs and clinician assessments of pain and motor problems. However, the higher frequency of disagreements regarding learning difficulties emphasizes the importance of incorporating patient and clinician evaluations in pediatric FNSD treatment.
Collapse
Affiliation(s)
- S. Barak
- Department of Nursing, Faculty of Health Sciences, Ariel University, Ariel, Israel
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - J. Landa
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - E. Eisenstein
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - M. Gerner
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - T. Ravid Vulkan
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - E. Neeman-Verblun
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - T. Silberg
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| |
Collapse
|
2
|
Simpson A, Tallur KK, Chin RFM, Yong K, Stone J. Autism spectrum disorder in children and young people with FND. J Psychosom Res 2024; 182:111681. [PMID: 38692183 DOI: 10.1016/j.jpsychores.2024.111681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Alexander Simpson
- Department of Paediatric Neurology, Royal Hospital for Children and Young People, Edinburgh, UK.
| | | | - Richard F M Chin
- Department of Paediatric Neurology, Royal Hospital for Children and Young People, Edinburgh, UK; Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneith Yong
- Rehab2Kids, Sydney Children's Hospital, Sydney, Australia
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
3
|
Schievink WI, Maya MM, Taché RB, Walker CT. Pediatric post-dural puncture headache and paraplegia. Headache 2024; 64:865-868. [PMID: 38860510 DOI: 10.1111/head.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 06/12/2024]
Abstract
A cerebrospinal fluid (CSF) leak developed in a 14-year-old girl and a 12-year-old boy following a diagnostic lumbar puncture. Two days and sixteen years later, respectively, paraplegia developed due to a functional disorder. Imaging revealed an extensive extradural CSF collection in both patients and digital subtraction myelography was required to pinpoint the exact site of a ventral dural puncture hole where the lumbar spinal needle had gone "through and through" the dural sac. The CSF leak was complicated by cortical vein thrombosis in one patient. Both patients underwent uneventful surgical repair of the ventral dural puncture hole with prompt resolution of the paraplegia. Iatrogenic ventral CSF leaks may become exceptionally long standing and may be complicated by paraplegia on a functional basis both in the acute and chronic phases.
Collapse
Affiliation(s)
- Wouter I Schievink
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marcel M Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rachelle B Taché
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Corey T Walker
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
4
|
Baglioni V, Esposito D, Bernardi K, Novelli M, Zaccaria V, Galosi S, Pisani F. Misdiagnosis of functional neurological symptom disorders in paediatrics: Narrative review and relevant case report. Clin Child Psychol Psychiatry 2024; 29:1026-1042. [PMID: 38515429 DOI: 10.1177/13591045241240805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Functional neurological symptom disorders (FNSD) pose a common challenge in clinical practice, particularly in pediatric cases where the clinical phenotypes can be intricate and easily confused with structural disturbances. The frequent coexistence of FNSDs with other medical disorders often results in misdiagnosis. In this review, we highlight the distinctions between FNSD and various psychiatric and neurological conditions. Contrary to the misconception that FNSD is a diagnosis of exclusion, we underscore its nature as a diagnosis of inclusion, contingent upon recognizing specific clinical features. However, our focus is on a critical learning point illustrated by the case of a 14-year-old male initially diagnosed with FNSD, but subsequently found to have a rare primary monogenic movement disorder (paroxysmal kinesigenic dyskinesia, PKD). The crucial takeaway from this case is the importance of avoiding an FNSD diagnosis based solely on psychiatric comorbidity and suppressible symptoms. Instead, clinicians should diligently assess for specific features indicative of FNSD, which were absent in this case. This emphasizes the importance of making a diagnosis of inclusion. Extended follow-up and clinical-oriented genetic testing might help identify comorbidities, prevent misdiagnosis, and guide interventions in complex cases, which cannot be simply classified as "functional" solely because other conditions can be excluded.
Collapse
Affiliation(s)
- Valentina Baglioni
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Dario Esposito
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Katerina Bernardi
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Maria Novelli
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Valerio Zaccaria
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Serena Galosi
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Francesco Pisani
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| |
Collapse
|
5
|
Watson M, Kreuzman J, Zeribi K, Iskander JM, Hopper A, Simon L, Chesley G, Fobian A. The Current State of Pediatric Functional Neurological Disorder Treatment in the United States. Pediatr Neurol 2024; 158:144-155. [PMID: 39059300 DOI: 10.1016/j.pediatrneurol.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/15/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Pediatric functional neurological disorders (FNDs) are common but grossly under-researched. This survey study aims to define the current landscape of pediatric FND treatment in the United States, identifying treatment programs, care team composition, treatment approaches, and aftercare management. METHODS The Functional Neurological Disorder Society (FNDS) Pediatric Special Interest Group (SIG), a diverse set of clinician and caregiver stakeholders, collected information on available treatment programs in the United States via survey. Current programs were identified through the FNDS Pediatric SIG and FND Hope's provider registry. RESULTS Thirty-nine care team members from 24 health care centers yielded 31 unique FND treatment settings. Centers existed in 16 states, concentrated in the Midwest and Southern regions. Outpatient settings (62%) were more prevalent than inpatient. A psychologist (PhD/PsyD) was the most common clinician (52%) with dedicated time to treat FNDs. Most settings accepted ages six to 21 (55%) and treated all FND symptoms (77%). A spectrum of treatment approaches was endorsed with the most common being cognitive behavioral therapy (77%) and personalized approaches (58%). A biopsychosocial approach was evident, with most settings reporting active involvement with school (97%) and caregivers (94%). Most settings (74%) encouraged treatment re-engagement when needed with no strict time limits. All respondents provided aftercare recommendations or referrals. CONCLUSIONS Pediatric FND treatment is available across the United States, but there is high variability in care team membership, treatment approach, and aftercare management. Future research is necessary to develop effective and sustainable treatment to improve access for this population.
Collapse
Affiliation(s)
- Meagan Watson
- Department of Neurology, University of Colorado, Aurora, Colorado.
| | - Jason Kreuzman
- St Louis Children's Hospital, Allied Health/Therapy Services, St Louis, Missouri
| | - Karen Zeribi
- Shift-Results, Health Systems Improvement Consulting, Seattle, Washington
| | - Jeannette M Iskander
- Department of NeuroBehavioral Health, NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, Ohio
| | | | - Laura Simon
- Department of Pediatric Rehabilitation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gayle Chesley
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aaron Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
6
|
Wu X, Zhou Y, Xi Y, Zhou H, Tang Z, Xiong L, Qin D. Polyphenols: Natural Food-Grade Biomolecules for the Treatment of Nervous System Diseases from a Multi-Target Perspective. Pharmaceuticals (Basel) 2024; 17:775. [PMID: 38931442 PMCID: PMC11206395 DOI: 10.3390/ph17060775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Polyphenols are the most prevalent naturally occurring phytochemicals in the human diet and range in complexity from simple molecules to high-molecular-weight polymers. They have a broad range of chemical structures and are generally categorized as "neuroprotective", "anti-inflammatory", and "antioxidant" given their main function of halting disease onset and promoting health. Research has shown that some polyphenols and their metabolites can penetrate the blood-brain barrier and hence increase neuroprotective signaling and neurohormonal effects to provide anti-inflammatory and antioxidant effects. Therefore, multi-targeted modulation of polyphenols may prevent the progression of neuropsychiatric disorders and provide a new practical therapeutic strategy for difficult-to-treat neuropsychiatric disorders. Therefore, multi-target modulation of polyphenols has the potential to prevent the progression of neuropsychiatric disorders and provide a new practical therapeutic strategy for such nervous system diseases. Herein, we review the therapeutic benefits of polyphenols on autism-spectrum disorders, anxiety disorders, depression, and sleep disorders, along with in vitro and ex vivo experimental and clinical trials. Although their methods of action are still under investigation, polyphenols are still seldom employed directly as therapeutic agents for nervous system disorders. Comprehensive mechanistic investigations and large-scale multicenter randomized controlled trials are required to properly evaluate the safety, effectiveness, and side effects of polyphenols.
Collapse
Affiliation(s)
- Xinchen Wu
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming 650500, China; (X.W.); (Y.Z.); (Y.X.)
| | - Yang Zhou
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming 650500, China; (X.W.); (Y.Z.); (Y.X.)
| | - Yujiang Xi
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming 650500, China; (X.W.); (Y.Z.); (Y.X.)
| | - Haimei Zhou
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Kunming 650500, China; (H.Z.); (Z.T.)
| | - Zhengxiu Tang
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Kunming 650500, China; (H.Z.); (Z.T.)
| | - Lei Xiong
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming 650500, China; (X.W.); (Y.Z.); (Y.X.)
| | - Dongdong Qin
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Kunming 650500, China; (H.Z.); (Z.T.)
- Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Neuropsychiatric Diseases, Yunnan University of Chinese Medicine, Kunming 650500, China
| |
Collapse
|
7
|
Kozlowska K, Scher S. Recent advances in understanding the neurobiology of pediatric functional neurological disorder. Expert Rev Neurother 2024; 24:497-516. [PMID: 38591353 DOI: 10.1080/14737175.2024.2333390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Functional neurological disorder (FND) is a neuropsychiatric disorder that manifests in a broad array of functional motor, sensory, or cognitive symptoms, which arise from complex interactions between brain, mind, body, and context. Children with FND make up 10%-20% of presentations to neurology services in children's hospitals and up to 20% of adolescents admitted to hospital for the management of intractable seizures. AREAS COVERED The current review focuses on the neurobiology of pediatric FND. The authors present an overview of the small but growing body of research pertaining to the biological, emotion-processing, cognitive, mental health, physical health, and social system levels. EXPERT OPINION Emerging research suggests that pediatric FND is underpinned by aberrant changes within and between neuron-glial (brain) networks, with a variety of factors - on multiple system levels - contributing to brain network changes. In pediatric practice, adverse childhood experiences (ACEs) are commonly reported, and activation or dysregulation of stress-system components is a frequent finding. Our growing understanding of the neurobiology of pediatric FND has yielded important flow-on effects for assessing and diagnosing FND, for developing targeted treatment interventions, and for improving the treatment outcomes of children and adolescents with FND.
Collapse
Affiliation(s)
- Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead, NSW, Australia
- Brain Dynamics Centre, Westmead Institute of Medical Research, Westmead, NSW, Australia
- University of Sydney Medical School, Camperdown, NSW, Australia
| | - Stephen Scher
- University of Sydney Medical School, Camperdown, NSW, Australia
- Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
- McLean Hospital, Belmont, MA, USA
| |
Collapse
|
8
|
Mavroudis I, Kazis D, Kamal FZ, Gurzu IL, Ciobica A, Pădurariu M, Novac B, Iordache A. Understanding Functional Neurological Disorder: Recent Insights and Diagnostic Challenges. Int J Mol Sci 2024; 25:4470. [PMID: 38674056 PMCID: PMC11050230 DOI: 10.3390/ijms25084470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic purpose. These signs, which can consist of motor, sensory, or cognitive disturbances, are not deliberately produced and often vary in severity. Its diagnosis is predicated on clinical evaluation and the exclusion of other medical or psychiatric situations. Its treatment typically involves a multidisciplinary technique addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions. Recent advances in neuroimaging and a deeper exploration of its epidemiology, pathophysiology, and clinical presentation have shed new light on this disorder. This paper synthesizes the current knowledge on FND, focusing on its epidemiology and underlying mechanisms, neuroimaging insights, and the differentiation of FND from feigning or malingering. This review highlights the phenotypic heterogeneity of FND and the diagnostic challenges it presents. It also discusses the significant role of neuroimaging in unraveling the complex neural underpinnings of FND and its potential in predicting treatment response. This paper underscores the importance of a nuanced understanding of FND in informing clinical practice and guiding future research. With advancements in neuroimaging techniques and growing recognition of the disorder's multifaceted nature, the paper suggests a promising trajectory toward more effective, personalized treatment strategies and a better overall understanding of the disorder.
Collapse
Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK;
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Fatima Zahra Kamal
- Higher Institute of Nursing Professions and Health Technical (ISPITS), Marrakech 40000, Morocco
- Laboratory of Physical Chemistry of Processes and Materials, Faculty of Sciences and Techniques, Hassan First University, Settat 26000, Morocco
| | - Irina-Luciana Gurzu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (A.I.)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Carol I Avenue 20th A, 700505 Iasi, Romania
- Center of Biomedical Research, Romanian Academy, Iasi Branch, Teodor Codrescu 2, 700481 Iasi, Romania
- Academy of Romanian Scientists, 3 Ilfov, 050044 Bucharest, Romania
- Preclinical Department, Apollonia University, Păcurari Street 11, 700511 Iasi, Romania
| | - Manuela Pădurariu
- “Socola” Institute of Psychiatry, Șoseaua Bucium 36, 700282 Iasi, Romania;
| | - Bogdan Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (A.I.)
| | - Alin Iordache
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (A.I.)
| |
Collapse
|
9
|
Kahlon S, Barton CR, Abu Libdeh A, O'Malley JA, Pearson T, Waugh JL, Wu SW, Zea Vera AG, Kruer MC. Emerging Subspecialties: Pediatric Movement Disorders Neurology. Neurology 2024; 102:e208050. [PMID: 38165345 DOI: 10.1212/wnl.0000000000208050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Pediatric movement disorders (PMD) neurologists care for infants, children, and adolescents with conditions that disrupt typical movement; serving as important subspecialist child neurologists in both academic and private practice settings. In contrast to adult movement disorders neurologists whose "bread and butter" is hypokinetic Parkinson disease, PMD subspecialty practice is often dominated by hyperkinetic movement disorders including tics, dystonia, chorea, tremor, and myoclonus. PMD neurology practice intersects with a variety of subspecialties, including neonatology, developmental pediatrics, rehabilitation medicine, epilepsy, child & adolescent psychiatry, psychology, orthopedics, genetics & metabolism, and neurosurgery. Over the past several decades, significant advancements in the PMD field have included operationalizing definitions for distinct movement disorders, recognizing the spectrum of clinical phenotypes, expanding research on genetic and neuroimmunologic causes of movement disorders, and advancing available treatments. Subspecialty training in PMD provides trainees with advanced clinical, diagnostic, procedural, and management skills that reflect the complexities of contemporary practice. The child neurologist who is fascinated by the intricacies of child motor development, appreciates the power of observation skills coupled with a thoughtful physical examination, and is excited by the challenge of the unknown may be well-suited to a career as a PMD specialist.
Collapse
Affiliation(s)
- Simran Kahlon
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Christopher R Barton
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Amal Abu Libdeh
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Jennifer A O'Malley
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Toni Pearson
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Jeff L Waugh
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Steve W Wu
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Alonso G Zea Vera
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Michael C Kruer
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| |
Collapse
|
10
|
Dan B. DMCN 2023 highlights: Methodology, ethics, and artificial intelligence in childhood disability research. Dev Med Child Neurol 2023; 65:1541-1542. [PMID: 37632143 DOI: 10.1111/dmcn.15740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
|
11
|
Kozlowska K, Schollar-Root O, Savage B, Hawkes C, Chudleigh C, Raghunandan J, Scher S, Helgeland H. Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1724. [PMID: 38002815 PMCID: PMC10670544 DOI: 10.3390/children10111724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/26/2023]
Abstract
Previous studies suggest that subjective distress in children with functional neurological disorder (FND) is associated with stress-system dysregulation and modulates aberrant changes in neural networks. The current study documents illness-promoting psychological processes in 76 children with FND (60 girls and 16 boys, aged 10.00-17.08 years) admitted to the Mind-Body Program. The children completed a comprehensive family assessment and self-report measures, and they worked with the clinical team to identify psychological processes during their inpatient admission. A total of 47 healthy controls (35 girls and 12 boys, aged 8.58-17.92 years) also completed self-report measures, but were not assessed for illness-promoting psychological processes. Children with FND (vs. controls) reported higher levels of subjective distress (total DASS score, t(104.24) = 12.18; p ˂ 0.001) and more adverse childhood experiences across their lifespans (total ELSQ score, t(88.57) = 9.38; p ˂ 0.001). Illness-promoting psychological processes were identified in all children with FND. Most common were the following: chronic worries about schoolwork, friendships, or parental wellbeing (n = 64; 84.2%); attention to symptoms (n = 61; 80.3%); feeling sad (n = 58; 76.3%); experiencing a low sense of control (helplessness) in relation to symptoms (n = 44; 57.9%); pushing difficult thoughts out of mind (n = 44; 57.9%); self-critical rumination (n = 42; 55.3%); negative/catastrophic-symptom expectations (n = 40; 52.6%); avoidance of activities (n = 38; 50%); intrusive thoughts/feelings/memories associated with adverse events (n = 38, 50%); and pushing difficult feelings out of mind (n = 37; 48.7%). In children with FND-disabled enough to be admitted for inpatient treatment-illness-promoting psychological processes are part of the clinical presentation. They contribute to the child's ongoing sense of subjective distress, and if not addressed can maintain the illness process. A range of clinical interventions used to address illness-promoting psychological processes are discussed, along with illustrative vignettes.
Collapse
Affiliation(s)
- Kasia Kozlowska
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Child and Adolescent Heath and Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Brain Dynamics Centre, Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Olivia Schollar-Root
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Blanche Savage
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Golden Wattle Clinical Psychology, 20 Jarrett St, Leichhardt, NSW 2040, Australia
| | - Clare Hawkes
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Catherine Chudleigh
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Golden Wattle Clinical Psychology, 20 Jarrett St, Leichhardt, NSW 2040, Australia
| | - Jyoti Raghunandan
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Stephen Scher
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Helene Helgeland
- Department of Child and Adolescent Mental Health in Hospitals, Oslo University Hospital, 0424 Oslo, Norway;
| |
Collapse
|
12
|
Wilkinson-Smith A, Lerario MP, Klindt KN, Waugh JL. A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic. J Child Neurol 2023; 38:631-641. [PMID: 37691316 DOI: 10.1177/08830738231200520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Youth who identify as transgender and gender nonconforming (TGNC) are at increased risk of anxiety, depression, bullying, and loss of social and family support. These factors may increase the risk of developing functional neurologic disorder (FND). If the risk of FND is increased in TGNC youth, then identifying which youth are at increased risk, and the particular times when risk is increased, may allow for earlier diagnosis and treatment of FND. Better awareness of functional symptoms among clinicians who care for TGNC youth may prevent disruption of gender-affirming care if FND symptoms emerge. Patients diagnosed with FND who are TGNC may require different forms of intervention than other youth with FND. We present 4 cases from our multidisciplinary pediatric FND program of TGNC youth who developed FND. In all individuals for whom follow-up information was available, access to gender-affirming health care was associated with marked improvement or resolution of FND symptoms.
Collapse
Affiliation(s)
- Alison Wilkinson-Smith
- Department of Psychiatry, Children's Medical Center, Dallas, TX, USA
- Department of Pediatrics, Division of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Mackenzie P Lerario
- Fordham Graduate School of Social Service, New York, NY, USA
- Greenburgh Pride, Greenburgh, NY, USA
| | - Kelsey N Klindt
- Department of Psychiatry, Children's Medical Center, Dallas, TX, USA
| | - Jeff L Waugh
- Department of Pediatrics, Division of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
- Department of Pediatrics, Division of Pediatric Neurology, University of Texas Southwestern, Dallas, TX, USA
| |
Collapse
|
13
|
Joffe AR, Elliott A. Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response. SAGE Open Med 2023; 11:20503121231194400. [PMID: 37655303 PMCID: PMC10467233 DOI: 10.1177/20503121231194400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.
Collapse
Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - April Elliott
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
14
|
Waugh JL. Functional symptoms in children may be much more common than previously believed. Dev Med Child Neurol 2023. [PMID: 36890658 DOI: 10.1111/dmcn.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Jeff L Waugh
- Division of Pediatric Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
| |
Collapse
|