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Robinson SJ, Colville GA. Management of medically unexplained symptoms in children and young people: a secondary analysis of a 10-year audit of referrals to a Paediatric Psychology Service. BMJ Paediatr Open 2024; 8:e002765. [PMID: 39209440 DOI: 10.1136/bmjpo-2024-002765] [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] [Received: 05/18/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
This study evaluated service use of children and young people with medically unexplained symptoms (MUS) referred to a Paediatric Psychology Service between 2008 and 2017. Univariate analyses of activity data indicated that the MUS group (n=268) required more clinical sessions than other patients (n=3577) (inpatient MUS: 7.5 (12.5) vs general: 4.0 (6.0), p=0.006; outpatient: MUS 10.7 (15.0) vs general 6.3 (8.9), p<0.001). Multivariate analyses confirmed that MUS group status remained significantly associated (p<0.001) with a higher number of contacts, even when age and gender were controlled for. Although both groups benefitted equally from psychological input, MUS referrals required more contact time than general referrals.
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Affiliation(s)
- Sally J Robinson
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Gillian A Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
- Population Health Research Institute, St George's University of London, London, UK
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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.
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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
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Ludlow AK, Anderson S, Robinson S, Owen T, Hedderly T. An investigation into mothers' experiences of their children's functional tic-like behaviour and tic attacks. PLoS One 2024; 19:e0292742. [PMID: 38166108 PMCID: PMC10760889 DOI: 10.1371/journal.pone.0292742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/27/2023] [Indexed: 01/04/2024] Open
Abstract
OBJECTIVE This is the first study to systematically explore the lived experiences of sudden and new onset of severe functional tics from the perspective of the mother's experiences and describes their attempts to access support services in the United Kingdom. METHOD Twenty-One mothers of young people aged between 12 to 17 years with functional tic-like behaviour (FTLB) took part in semi-structured interviews. Thematic analysis of the transcribed interviews revealed gaps and inconsistencies within the process of gaining access to professional services and a lack of support for the management of tics and functional tic-like movements, in addition to highlighting the impact it had on daily family life. RESULTS The themes generated included the occurrence and development of tics, the severity and intensity of symptoms, the psychological impact on the family and the need to make recommendations for a clear care pathway. Managing the impact of the FTLB and co-occurring conditions such as suicidal ideation and self-harm, as well as the physical and emotional trauma, commonly contributed to feelings of isolation and helplessness, which impacted negatively on the family's ability to function and participate in society. CONCLUSIONS The findings emphasize the urgent need to create a clear management pathway for those experiencing FTLB, including the need for more professionals with relevant knowledge, to improve the dialogue with families during the referral process, whilst prioritising the treatment of anxiety and other identified mental health concerns.
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Affiliation(s)
- Amanda K. Ludlow
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, United Kingdom
| | | | - Sally Robinson
- Southend, Essex and Thurrock Child and Adolescent Mental Health Services, North East London NHS Foundation Trust, London, United Kingdom
| | - Tamsin Owen
- TANDeM, Evelina London Children’s Hospital Guy’s and St Thomas’, London, United Kingdom
| | - Tammy Hedderly
- TANDeM, Evelina London Children’s Hospital Guy’s and St Thomas’, London, United Kingdom
- Kings College London Faculty of Life Sciences and Medicine, London, United Kingdom
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Nilles C, Szejko N, Martino D, Pringsheim T. Prospective follow-up study of youth and adults with onset of functional tic-like behaviours during the COVID-19 pandemic. Eur J Neurol 2024; 31:e16051. [PMID: 37644767 PMCID: PMC11235764 DOI: 10.1111/ene.16051] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND PURPOSE Very little is known about the long-term prognosis of patients with functional tic-like behaviours (FTLBs). We sought to characterize the trajectory of symptom severity over a 12-month period. METHODS Patients with FTLBs were included in our prospective longitudinal child and adult clinical tic disorder registries at the University of Calgary. Patients were prospectively evaluated 6 and 12 months after their first clinical visit. Tic inventories and severity were measured with the Yale Global Tic Severity Scale (YGTSS). RESULTS Eighty-three youths and adults with FTLBs were evaluated prospectively until April 2023. Mean YGTSS total tic severity scores were high at baseline, with a mean score of 29.8 points (95% confidence interval [CI] = 27.6-32.1). Fifty-eight participants were reevaluated at 6 months, and 32 participants were reevaluated at 12 months. The YGTSS total tic severity score decreased significantly from the first clinical visit to 6 months (raw mean difference = 8.9 points, 95% CI = 5.1-12.7, p < 0.0001), and from 6 to 12 months (raw mean difference = 6.4 points, 95% CI = 0.8-12.0, p = 0.01). Multivariable linear regression demonstrated that tic severity at initial presentation and the presence of other functional neurological symptoms were associated with higher YGTSS total tic scores at 6 months, whereas younger age at baseline, receiving cognitive behavioural therapy for anxiety and/or depression, and prescription of selective serotonin reuptake inhibitors were associated with lower YGTSS total tic scores at 6 months. CONCLUSIONS We observed a meaningful improvement in tic severity scores in youth and adults with FTLBs over a period of 6-12 months.
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Affiliation(s)
- Christelle Nilles
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Natalia Szejko
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Davide Martino
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
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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.
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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;
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Kozlowska K, Chudleigh C, Savage B, Hawkes C, Scher S, Nunn KP. Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder. Harv Rev Psychiatry 2023; 31:60-82. [PMID: 36884038 PMCID: PMC9997641 DOI: 10.1097/hrp.0000000000000358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
LEARNING OBJECTIVES • Develop and implement treatment plans for children and adolescents with functional neurological disorder (FND)• Outline a plan to increase awareness and standardize the care for patients with FND using evidence-based interventions. ABSTRACT Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however-and worldwide-FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real ("organic") disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children's Hospital at Westmead in Sydney, Australia-run by a consultation-liaison team-has delivered inpatient care to hundreds of patients with FND and outpatient care to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND. Our aim is to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings.
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Gigliotti F, Di Santo F, Cesario S, Esposito D, Manti F, Galosi S, Ferrara M, Leuzzi V, Baglioni V. Psychogenic non-epileptic seizures and functional motor disorders in developmental age: A comparison of clinical and psychopathological features. Epilepsy Behav 2023; 140:109117. [PMID: 36804846 DOI: 10.1016/j.yebeh.2023.109117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Psychogenic Non-Epileptic Seizures (PNES) and Functional Motor Disorders (FMDs) commonly represent the main clinical manifestations of Functional Neurological Disorders (FNDs). Despite their high prevalence in pediatric neurological services, literature on this topic is still spare for this population. The present study aimed to deepen the clinical knowledge of a pediatric FNDs sample through a demographic and clinical characterization of the most recurrent clinical patterns during the pediatric age. Moreover, a comparison of neuropsychological and psychopathological profiles of PNES and FMD patients was carried out to identify specific vulnerabilities and therapeutic targets linked with these different clinical manifestations. MATERIALS AND METHODS A total of 43 FNDs patients (age range 7-17 years old) were retrospectively included in our study, enrolled in two subgroups: 20 with FMDs and 23 with PNES diagnosis. They were inpatients and outpatients referred over a period of 5 years and a standardized neurological, neuropsychological (WISC-IV/WAIS-IV), and psychiatric (CDI-2, MASC-2, ADES, DIS-Q, PID-5) evaluation was assessed. RESULTS In PNES patients the most common clinical phenotypes were functional tonic-clonic (52%) and atonic (32%) manifestations while in the FMDs group were gait alterations (60%), functional myoclonus (35%), and tremor (35%). A higher frequency of cognitive impairment was reported in PNES patients with higher anxiety-depressive symptom rates than FMDs patients. CONCLUSIONS Notably, specific neurocognitive and psychopathological profiles were described in PNES and FMDs, highlighting higher cognitive and psychiatric vulnerabilities in PNES, suggesting as well different strategy for therapeutic approaches.
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Affiliation(s)
- F Gigliotti
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - F Di Santo
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - S Cesario
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - D Esposito
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - F Manti
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - S Galosi
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - M Ferrara
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - V Leuzzi
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - V Baglioni
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
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Yong K, Chin RFM, Shetty J, Hogg K, Burgess K, Lindsay M, McLellan A, Stone J, KamathTallur K. Functional neurological disorder in children and young people: Incidence, clinical features, and prognosis. Dev Med Child Neurol 2023. [PMID: 36752054 DOI: 10.1111/dmcn.15538] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/09/2023]
Abstract
AIM To report incidence, demographic and clinical characteristics, and symptom outcome of functional neurological disorder (FND) in children. METHOD Children diagnosed with FND at a regional children's hospital were prospectively recruited by weekly active surveillance for 36 months. Demographic, clinical, and follow-up data were retrospectively extracted by review of electronic records. Descriptive statistical analyses were used. RESULTS Ninety-seven children (age range 5-15 years) met the case definition of FND (annual incidence 18.3 per 100 000 children). Children with FND were likely to be female (n = 68 [70%]) and older (median 13 years) with no difference in the Scottish Index of Multiple Deprivation (marker of socioeconomic status) compared with the general childhood population. Functional motor (41%) and sensory (41%) symptoms were most common; other somatic symptoms such as headache (31%) and pain (27%) were frequent. Self-reported psychiatric symptoms and infection/inflammation were the most common predisposing and precipitating factors respectively. At a median of 15 months follow-up, 49% of 75 children reported improvement or resolution of FND symptoms with no prognostic factors found. INTERPRETATION At this regional centre, FND in children had a higher incidence than previously reported and a less optimistic outcome than in some other studies.
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Affiliation(s)
- Kenneith Yong
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Richard F M Chin
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK.,Child Life and Health, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Jay Shetty
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK.,Child Life and Health, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Kirsty Hogg
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Kieran Burgess
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Max Lindsay
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Ailsa McLellan
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Krishnaraya KamathTallur
- Department of Clinical Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK
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Landa J, Gerner M, Eisenstein E, Barak S. Pediatric Functional Neurological Symptoms Disorder: Walking Ability and Perceived Exertion Post-Pediatric Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1631. [PMID: 36674392 PMCID: PMC9867415 DOI: 10.3390/ijerph20021631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adolescents with functional neurological symptoms disorder (FNSD) commonly present walking abnormalities. Walking is influenced by 'objective' (e.g., fitness) and 'subjective' (e.g., fear) components. Rate of perceived exertion (RPE) reflects the interaction between these two components. This study compared the walking ability and RPE before and after rehabilitation of adolescents with FNSD to adolescents with moderate-to-severe traumatic brain injury (TBI). Factors predicting walking and RPE were also examined. METHODS Adolescents with FNSD (n = 31) and adolescents with moderate-to-severe TBI (n = 28) aged 6 to 18 years participated in the study. Participants received a multidisciplinary rehabilitation program. Six-minute walk test (6MWT) and RPE were assessed before and after rehabilitation. RESULTS At pre-test, the TBI group presented lower RPE than the FNSD group (3.38 ± 2.49 and 6.25 ± 2.71, respectively). In the FNSD group, pre-test 6MWT was a significant predictor of post-test 6MWT (adjusted R2 = 0.17; p = 0.01). In the TBI group, post-test 6MWT was significantly predicted by both the pre-test 6MWT and age (adjusted R2 = 0.16; p = 0.04). CONCLUSIONS Prior to the intervention, adolescents with FNSD perceived walking as a more difficult activity than adolescents with TBI. Post-intervention, although the intervention was effective in terms of changes in 6MWT and RPE, the 'subjective' component still contributed to the elevated RPE of the FNSD group.
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Affiliation(s)
- Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat Gan 5265601, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Maya Gerner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Etzyona Eisenstein
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Sharon Barak
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat Gan 5265601, Israel
- Department of Nursing, Faculty of Health Science, Ariel University, Ariel 40700, Israel
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Perjoc RS, Roza E, Vladacenco OA, Teleanu DM, Neacsu R, Teleanu RI. Functional Neurological Disorder-Old Problem New Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1099. [PMID: 36673871 PMCID: PMC9859618 DOI: 10.3390/ijerph20021099] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Functional neurological disorder (FND) is a common issue in the pediatric population. The concept and our understanding of functional neurological disorders have changed over the past years, and new etiologic models and treatment plans have been explored. Knowledge about FND in the pediatric population, however, is lacking. The aim of this review is to provide an update on pediatric functional neurological disorder. We conducted a literature search of PubMed and SCOPUS databases and reviewed a total of 85 articles to gain insight into the current understanding of FND etiology, diagnosis, treatment, and prognosis in children and adolescents. Functional and high resolution MRI revealed abnormal connectivity and structural changes in patients with functional symptoms. The diagnostic criteria no longer require the presence of a psychological factor and instead focus on a rule-in diagnosis. Treatment of FND includes a clear communication of the diagnosis and the support of a multidisciplinary team. Although FND typically has a poor prognosis, better outcomes appear to have been achieved in children and young adults. We conclude that pediatric functional neurological disorder is a prevalent pathology and that this patient population has additional specific needs compared to the adult population.
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Affiliation(s)
- Radu-Stefan Perjoc
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
| | - Eugenia Roza
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
| | - Oana Aurelia Vladacenco
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
| | - Daniel Mihai Teleanu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Emergency University Hospital, 050098 Bucharest, Romania
| | - Roxana Neacsu
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
| | - Raluca Ioana Teleanu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
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Rohatgi K, Agarwal V, Singh S, Gupta PK. Longitudinal outcome of Functional Neurological Disorder in Children and Adolescents in a Tertiary Care centre from Northern India. Asian J Psychiatr 2023; 79:103332. [PMID: 36423424 DOI: 10.1016/j.ajp.2022.103332] [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: 09/09/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022]
Abstract
FND is common in Indian children and adolescents. Outcome related factors are not well known. With objective to study short-term outcome of FND, prospective, longitudinal, nine months follow-up study of 6-16 years was planned. Socioeconomic, clinical variables, I.Q. and personality traits at baseline and new psychiatric/physical illness, psychosocial factors and comorbidities during follow-up were assessed. Out of 68 children, scholastic (64.7%) and family problems (23.5%) were common psychosocial factors. After nine months,73% achieved remission. Reasons for non-remission were persistence of psychosocial factors and psychiatric comorbidities. A need arises for increasing awareness among general practitioners for early identification and management.
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Affiliation(s)
- Kopal Rohatgi
- Department of Psychiatry, King George's Medical University, Lucknow 226003, U.P., India.
| | - Vivek Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow 226003, U.P., India.
| | - Shweta Singh
- Department of Psychiatry, King George's Medical University, Lucknow 226003, U.P., India.
| | - Pawan Kumar Gupta
- Department of Psychiatry, King George's Medical University, Lucknow 226003, U.P., India.
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12
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Nakamura A, Tanaka K. A boy with dissociative symptoms who benefited from biopsychosocial assessment. Pediatr Int 2023; 65:e15502. [PMID: 36790052 DOI: 10.1111/ped.15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Akio Nakamura
- Department of Child and Adolescent Liaison, Division of Mental Health Care, National Center for Child Health and Development, Tokyo, Japan
- Faculty of Medicine, Department of Pediatrics, Juntendo University, Tokyo, Japan
| | - Kyoko Tanaka
- Department of Child and Adolescent Liaison, Division of Mental Health Care, National Center for Child Health and Development, Tokyo, Japan
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13
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Chung J, Mukerji S, Kozlowska K. Cortisol and α-amylase awakening response in children and adolescents with functional neurological (conversion) disorder. Aust N Z J Psychiatry 2023; 57:115-129. [PMID: 35297291 DOI: 10.1177/00048674221082520] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Stress system dysregulation is considered to have an important role in the aetiology of paediatric functional neurological (conversion) disorder. This study examined salivary cortisol and α-amylase awakening responses in children with functional neurological disorder to determine activation patterns of the hypothalamic-pituitary-adrenal axis and sympathetic system. A healthy cortisol awakening response involves a robust increase in cortisol within 30 minutes of awakening. Alpha-amylase awakening response is variable in children. METHODS Cortisol and α-amylase were measured in saliva from 32 patients with functional neurological disorder (26 girls and 6 boys, aged 11.3-16.1 years) and 31 healthy controls (23 girls and 8 boys, aged 8.6-17.7 years). Saliva samples were collected using a Salivette sampling device at two time points - upon awakening and 30 minutes after awakening. RESULTS Patients with functional neurological disorder showed a decrease in cortisol awakening response (-4 nmol.min/L) and controls showed an increase (107 nmol.min/L), t(55) = -.4.6, p < 0.001. Within the functional neurological disorder group, 57% showed an attenuated cortisol awakening response and 43% showed an obliterated/reversed cortisol awakening response: Cortisol awakening response was negatively correlated with adverse childhood experiences, r(58) = -0.6, p = 0.002, and subjective distress (total Depression Anxiety and Stress Scales score), r(58) = -0.4, p = 0.050. In controls, cortisol awakening response showed no correlation with adverse childhood experiences and a positive correlation with subjective distress, r(56) = 0.4, p = 0.023. Total cortisol remained similar between the functional neurological disorder and control group. No significant differences were observed between the functional neurological disorder and control group in any of the α-amylase analyses. DISCUSSION The results suggest dysregulation of the hypothalamic-pituitary-adrenal axis in children with functional neurological disorder. Hypothalamic-pituitary-adrenal dysregulation in children with functional neurological disorder may contribute to comorbid symptoms of fatigue, sleep disturbance and subjective loss of well-being because circadian rhythms and energy metabolism are disrupted. Hypothalamic-pituitary-adrenal dysregulation - and changes in glucocorticoid (cortisol) signalling at the molecular level - may also contribute to increased vulnerability for functional neurological disorder symptoms because of epigenetically mediated changes to neural networks implicated in functional neurological disorder.
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Affiliation(s)
- Jason Chung
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Shohini Mukerji
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Chemical Pathology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Kasia Kozlowska
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research, Westmead, NSW, Australia
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14
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Arabia G, De Martino A, Moro E. Sex and gender differences in movement disorders: Parkinson's disease, essential tremor, dystonia and chorea. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:101-128. [PMID: 36038202 DOI: 10.1016/bs.irn.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex and gender-based differences in epidemiology, clinical features and therapeutical responses are emerging in several movement disorders, even though they are still not widely recognized. In this chapter, we summarize the most relevant evidence concerning these differences in Parkinson's disease, essential tremor, dystonia and chorea. Indeed, both sex-related biological (hormonal levels fluctuations) and gender-related variables (socio-cultural and environmental factors) may differently impact symptoms manifestation and severity, phenotype and disease progression of movement disorders on men and women. Moreover, sex differences in treatment responses should be taken into account in any therapeutical planning. Physicians need to be aware of these major differences between men and women that will eventually have a major impact on better tailoring prevention, treatment, or even delaying progression of the most common movement disorders.
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Affiliation(s)
- Gennarina Arabia
- Magna Graecia University, Movement Disorders Center, Neurology Unit, Catanzaro, Italy.
| | - Antonio De Martino
- Magna Graecia University, Movement Disorders Center, Neurology Unit, Catanzaro, Italy
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble Institute of Neurosciences, Grenoble, France
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15
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Howlett M, Martino D, Nilles C, Pringsheim T. Prognosis of rapid onset functional tic-like behaviors: Prospective follow-up over 6 months. Brain Behav 2022; 12:e2606. [PMID: 35593445 PMCID: PMC9226799 DOI: 10.1002/brb3.2606] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/23/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE The prognosis of rapid onset functional tic-like behaviors (FTLBs) is unknown. This prospective cohort study describes the course and treatment of rapid onset FTLBs in adolescents (n = 20) and adults (n = 9) previously reported in two case series. METHODS Yale Global Tic Severity Scale (YGTSS) scores were compared between first clinical presentation and 6-month follow-up assessment. All treatments used for FTLBs and any psychiatric comorbidities were recorded. RESULTS In adolescents with FTLBs, motor tics, vocal tics, total tics, impairment, and global scores on the YGTSS significantly improved at 6 months, with a mean decrease in the YGTSS global score of 31.9 points, 95% confidence interval (CI) 15.4, 48.4, p = .0005. In adults with FTLBs, only impairment and global scores significantly improved, with a mean decrease in the YGTSS global score of 19.6 points, 95% CI -3.2, 42.3, p = .04. Selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) for anxiety and depression were the most used treatment in both age groups. CONCLUSIONS This prospective study suggests that adolescents have a better prognosis than adults with FTLBs. Management of comorbidities with SSRIs and CBT seems effective.
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Affiliation(s)
- Megan Howlett
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Christelle Nilles
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tamara Pringsheim
- Mathison Centre for Mental Health Research and Education, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
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16
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Kim YN, Gray N, Jones A, Scher S, Kozlowska K. The Role of Physiotherapy in the Management of Functional Neurological Disorder in Children and Adolescents. Semin Pediatr Neurol 2022; 41:100947. [PMID: 35450664 DOI: 10.1016/j.spen.2021.100947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022]
Abstract
Children and adolescents with functional neurological (conversion) disorder (FND) present with symptoms of impaired motor and sensory function. FND involves complex interactions between the brain, mind, body, and lived experience of the child. The gold standard for treatment is therefore a holistic, biopsychosocial approach with multimodal interventions delivered by a multidisciplinary team. In this narrative review we examine the role of physiotherapy in managing FND in children. We searched Embase, Medline, PsycINFO, and PubMed (back to 2000) for relevant physiotherapy articles and also manually searched their reference lists. Two review articles and ten observational studies were identified. Data were extracted concerning the type of study, therapies involved, outcome measures, and comorbid mental health outcomes. FND symptoms resolved in 85% to 95% of the patients, and about two-thirds returned to full-time school after completing the multidisciplinary intervention. Ongoing mental health concerns at follow-up were associated with poorer functional outcomes. Key themes included the following: use of psychological interventions embedded in the physiotherapy intervention; integration of play, music, and dance; role of physical exercise in modulating physiological, neural, and endocrine systems; need for FND-specific outcome measures; ethical issues pertaining to randomized trials; and need to develop alternate study methodologies for assessing combined treatments. Clinical vignettes were included to highlight a range of physiotherapy interventions. In conclusion, the emerging literature suggests that physiotherapy for children with FND is a useful intervention for improving motor dysfunction and for addressing other concurrent issues such as physical deconditioning, neuroprotection, chronic pain, disturbed sleep, anxiety and depression, and resilience building.
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Affiliation(s)
- Yu-Na Kim
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nicola Gray
- Department of Physiotherapy, Sydney Children's Hospital Network, NSW, Australia
| | - Anna Jones
- Advance Rehab Centre, Artarmon, NSW, Australia
| | - Stephen Scher
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA; University of Sydney Medical School, NSW, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia; University of Sydney Medical School, NSW, Australia; Westmead Institute for Medical Research, Westmead, NSW, Australia.
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17
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Paleari V, Nisticò V, Nardocci N, Canevini MP, Priori A, Gambini O, Zorzi G, Demartini B. Socio-demographic characteristics and psychopathological assessment in a sample of 13 paediatric patients with functional neurological disorders: A preliminary report. Clin Child Psychol Psychiatry 2022; 27:492-503. [PMID: 34743581 DOI: 10.1177/13591045211055084] [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] [Indexed: 11/15/2022]
Abstract
This observational study aims to characterize, from a socio-demographic and psychopathological perspective, a sample of children with Functional Neurological Disorders (FND). Thirteen paediatric patients (below 18 years old) with FND and their parents completed a battery of anamnestic and neuropsychological tests, assessing socio-demographic status, cognitive level, behavioural and emotional issues, depression, anxiety, alexithymic traits and dissociative symptoms. Five patients presented movement disorders (tremor, myoclonus and gait disorder), three patients psychogenic non-epileptic seizures and five patients sensitivity disturbances (pain, anaesthesia and paraesthesia). Cognitive profile was normal in 11 patients; academic performance was good in nine patients, but three had a diagnosis of Specific Learning Difficulty or Attention Deficit Hyperactivity Disorder. Precipitating events occurred in 11 patients. At the self-report questionnaires, mean scores close to the clinical cut off were documented with respect to affective and somatic problems. At the parent-report questionnaires, clinically significant mean scores were observed in the subscales assessing anxious-depressive symptoms and somatic complaints. We speculate that paediatric FND patients, although acknowledging the relevance of somatic symptoms, have difficulties in recognizing internal emotional states (that, instead, are easily recognized by their parents). The case of one FND patient was described. These preliminary data might help identifying different clinical phenotypes of paediatric FND.
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Affiliation(s)
- Vittoria Paleari
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,U.O. Neuropsichiatria Infantile Fondazione IRCCS, 9328Istituto Neurologico Carlo Besta, Milano, Italia
| | - Veronica Nisticò
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy
| | - Nardo Nardocci
- U.O. Neuropsichiatria Infantile Fondazione IRCCS, 9328Istituto Neurologico Carlo Besta, Milano, Italia
| | - Maria Paola Canevini
- U.O. Neuropsichiatria Infantile ASST Santi Paolo e Carlo, Presidio San Paolo, Milano, Italy
| | - Alberto Priori
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy.,III Clinica Neurologica, ASST Santi Paolo e Carlo, Presidio San Paolo, Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy.,Unità di Psichiatria 52, ASST Santi Paolo e Carlo, Presidio San Paolo, Milano, Italy
| | - Giovanna Zorzi
- U.O. Neuropsichiatria Infantile Fondazione IRCCS, 9328Istituto Neurologico Carlo Besta, Milano, Italia
| | - Benedetta Demartini
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy.,Unità di Psichiatria 52, ASST Santi Paolo e Carlo, Presidio San Paolo, Milano, Italy
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18
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Elliott L, Carberry C. Treatment of Pediatric Functional Neurological Symptom Disorder: A Review of the State of the Literature. Semin Pediatr Neurol 2022; 41:100952. [PMID: 35450669 DOI: 10.1016/j.spen.2022.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
Functional Neurological Symptom Disorder (FNSD), or experiencing neurological symptoms incompatible with either a neurological condition or a medical condition, is a common condition presenting in children and adolescents. It is associated with impairment in quality of life for patients and their families and represents a significant burden to the healthcare system. There is currently limited research available regarding effective treatment of pediatric FNSD. Currently, only one RCT exists studying effective treatment of FNSD in children and adolescents, and it is limited to one sub-type of FNSD and only examined cognitive behavioral therapy compared to supportive therapy. Despite this, almost all published research supports good prognosis for pediatric FNSD with all studies reporting improvement either in FNSD symptoms or in the quality of life and functioning of patients with FNSD. The most support was found for the use of cognitive behavioral therapy either as a stand-alone treatment or in the context of interdisciplinary treatment. Future research should focus on increasing the rigor of research, including expanding RCTs to include additional sub-types of FNSD and comparing across various treatment modalities.
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Affiliation(s)
- Lindsey Elliott
- Department of Psychiatry and Behavioral Sciences, Univeristy of Texas at Austin, Austin, TX.
| | - Caroline Carberry
- Department of Educational Psychology, University of Texas at Austin, Austin, TX
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19
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Diagnosis and Initial Treatment of Functional Movement Disorders in Children. Semin Pediatr Neurol 2022; 41:100953. [PMID: 35450668 DOI: 10.1016/j.spen.2022.100953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
Abstract
Functional movement disorders (FMD) are complex neurobehavioral disorders that can be a significant source of disability for both children and their caregivers. While FMD in the adult population is better characterized, the aim of this paper is to review the pertinent clinical and historical features, diagnostic criteria, and multi-disciplinary management of FMD in the pediatric population. We highlight recent trends in pediatric FMD, including the increase in functional tic-like behaviors that has been observed during the COVID-19 pandemic.
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20
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Treatment Approaches for Functional Neurological Disorders in Children. Curr Treat Options Neurol 2022; 24:77-97. [PMID: 35370394 PMCID: PMC8958484 DOI: 10.1007/s11940-022-00708-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 12/18/2022]
Abstract
Abstract
Purpose of Review
Functional neurological disorder (FND) is a multi-network brain disorder that encompasses a broad range of neurological symptoms. FND is common in pediatric practice. It places substantial strains on children, families, and health care systems. Treatment begins at assessment, which requires the following: the medical task of making the diagnosis, the interpersonal task of engaging the child and family so that they feel heard and respected, the communication task of communicating and explaining the diagnosis, and the logistical task of organizing treatment.
Recent Findings
Over the past decade, three treatment approaches—Retraining and Control Therapy (ReACT), other cognitive-behavioral therapies, and multidisciplinary rehabilitation—have been evaluated in the USA, Canada, and Australia. Of children treated in such programs, 63 − 95% showed full resolution of FND symptoms. The common thread across the programs is their biopsychosocial approach—consideration of biological, psychological, relational, and school-related factors that contribute to the child’s clinical presentation.
Summary
Current research strongly supports a biopsychosocial approach to pediatric FND and provides a foundation for a stepped approach to treatment. Stepped care is initially tailored to the needs of the individual child (and family) based on the pattern and severity of FND presentation. The level of care and type of intervention may then be adjusted to consider the child’s response, over time, to treatment or treatment combinations. Future research is needed to confirm effective treatment targets, to inform the development of stepped care, and to improve methodologies that can assess the efficacy of stepped-care interventions.
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21
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Wiggins A, Raniti M, Gaafar D, Court A, Sawyer SM. Pediatric Somatic Symptom and Related Disorders: Parent Acceptance Influences Recovery. J Pediatr 2022; 241:109-114. [PMID: 34624318 DOI: 10.1016/j.jpeds.2021.09.054] [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: 05/09/2021] [Revised: 08/30/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess how clinicians discuss the diagnosis of somatic symptom and related disorders (SSRDs) in patients admitted to a children's hospital and explore the effect of parent and patient acceptance of the diagnosis on recovery. STUDY DESIGN In this cross-sectional study, we reviewed the electronic medical records of pediatric admissions diagnosed with SSRD over 18 months. All diagnostic discussions with patients and families were analysed to identify concepts used by clinicians within these discussions and the extent of parent and patient acceptance of the diagnosis. Recovery status up to 12 months after diagnosis was also identified. Acceptance and recovery were categorized as "full," "partial," or "none." RESULTS Ninety-five of 123 (77.2%) patients (median age 14.3 years, range 7.3-18.3) had at least 1 diagnostic discussion recorded. Clinical explanations within the diagnostic discussion spanned a variety of concepts, with the most common being a description of somatization (62%). Full parent acceptance of the diagnosis of SSRD was more likely when discussions involved two parents (P = .002). Full acceptance of the diagnosis by at least 1 parent was associated with complete functional recovery in their children (OR 8.94, 95% CI 2.24, 35.9, P = .002). In contrast, there was no significant association between full acceptance by patients and their recovery. CONCLUSION The influence of parent acceptance of the diagnosis of SSRD reinforces the importance of therapeutic engagement with families, as well as with children and adolescents.
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Affiliation(s)
- Aaron Wiggins
- Department of Mental Health, Royal Children's Hospital, Victoria, Australia.
| | - Monika Raniti
- Murdoch Children's Research Institute, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Victoria, Australia; Center for Adolescent Health, Royal Children's Hospital, Victoria, Australia
| | - Duaa Gaafar
- Department of Mental Health, Royal Children's Hospital, Victoria, Australia; Center for Adolescent Health, Royal Children's Hospital, Victoria, Australia
| | - Andrew Court
- Department of Mental Health, Royal Children's Hospital, Victoria, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Victoria, Australia; Center for Adolescent Health, Royal Children's Hospital, Victoria, Australia; Department of Adolescent Medicine, Royal Children's Hospital, Victoria, Australia
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22
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Altered resting-state neural networks in children and adolescents with functional neurological disorder. NEUROIMAGE: CLINICAL 2022; 35:103110. [PMID: 36002964 PMCID: PMC9421459 DOI: 10.1016/j.nicl.2022.103110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/14/2022] [Accepted: 07/10/2022] [Indexed: 11/24/2022] Open
Abstract
FND in children commonly involves presentation with multiple neurological symptoms. Children with FND show wide-ranging connectivity changes in resting-state neural networks. Aberrant neural-networks changes are greater in children whose FND includes functional seizures. Subjective distress, autonomic arousal, and HPA dysregulation contribute to network changes. Children with FND (vs controls) report more subjective distress and more ACEs across the lifespan.
Objectives Previous studies with adults suggest that aberrant communication between neural networks underpins functional neurological disorder (FND). The current study adopts a data-driven approach to investigate the extent that functional resting-state networks are disrupted in a pediatric mixed-FND cohort. Methods 31 children with mixed FND and 33 age- and sex-matched healthy controls completed resting-state fMRI scans. Whole-brain independent component analysis (pFWE < 0.05) was then used to identify group differences in resting-state connectivity. Self-report measures included the Depression, Anxiety and Stress Scale (DASS-21) and Early Life Stress Questionnaire (ELSQ). Resting-state heart rate (HR) and cortisol-awakening response (CAR) were available in a subset. Results Children with FND showed wide-ranging connectivity changes in eight independent components corresponding to eight resting-state neural networks: language networks (IC6 and IC1), visual network, frontoparietal network, salience network, dorsal attention network, cerebellar network, and sensorimotor network. Children whose clinical presentation included functional seizures (vs children with other FND symptoms) showed greater connectivity decreases in the frontoparietal and dorsal attentional networks. Subjective distress (total DASS score), autonomic arousal (indexed by HR), and HPA dysregulation (attenuated/reversed CAR) contributed to changes in neural network connectivity. Children with FND (vs controls) reported more subjective distress (total DASS score) and more adverse childhood experiences (ACEs) across their lifespan. Conclusions Children with FND demonstrate changes in resting-state connectivity. Identified network alterations underpin a broad range of functions typically disrupted in children with FND. This study complements the adult literature by suggesting that FND in children and adolescents emerges in the context of their lived experience and that it reflects aberrant communication across neural networks.
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23
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Perez DL, Aybek S, Popkirov S, Kozlowska K, Stephen CD, Anderson J, Shura R, Ducharme S, Carson A, Hallett M, Nicholson TR, Stone J, LaFrance WC, Voon V. A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders. J Neuropsychiatry Clin Neurosci 2021; 33:14-26. [PMID: 32778007 DOI: 10.1176/appi.neuropsych.19120357] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Selma Aybek
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Stoyan Popkirov
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Kasia Kozlowska
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Christopher D Stephen
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jordan Anderson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Robert Shura
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Simon Ducharme
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Alan Carson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Mark Hallett
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Timothy R Nicholson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jon Stone
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - W Curt LaFrance
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Valerie Voon
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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Gray N, Savage B, Scher S, Kozlowska K. Psychologically Informed Physical Therapy for Children and Adolescents With Functional Neurological Symptoms: The Wellness Approach. J Neuropsychiatry Clin Neurosci 2021; 32:389-395. [PMID: 32718273 DOI: 10.1176/appi.neuropsych.19120355] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Children with functional neurological disorder (FND) present with motor and sensory neurological symptoms that impair health and physical functioning and that create an ongoing clinical burden for caregivers and hospitals worldwide. Treatment programs for these children involve a multidisciplinary approach with physical therapy as a fundamental component. However, standard musculoskeletal approaches to physical therapy are ineffective or may even exacerbate symptoms because they are unresponsive to the biopsychosocial context in which FND emerges: FND typically occurs in the context of stress, either physical or emotional; symptoms are amplified by attention; and presentations are complicated by psychological factors. Informed, in part, by published guidelines for physical therapy with adult FND patients, this article examines common challenges that arise when working with children: overcoming previous negative encounters in the medical system; avoiding amplification of symptoms by drawing attention to them; and managing comorbid pain, falls, faints, nonepileptic seizures, dizziness, fatigue, and breathlessness, plus psychological symptoms such as anticipatory anxiety and panic attacks. What emerges is a psychologically informed therapeutic approach to physical therapy for children with functional neurological symptoms. This approach prioritizes interpersonal processes and physical therapy techniques that establish a therapeutic relationship and create a safe space for physical therapy, that use indirect physical therapy approaches redirecting the focus of attention away from symptoms and emphasizing the completion of tasks and activities engaging the sick body part indirectly, that tailor the intervention to address the needs and presentation of each particular child, and that integrate psychological interventions to manage common challenges.
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Affiliation(s)
- Nicola Gray
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Blanche Savage
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Stephen Scher
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Kasia Kozlowska
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
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25
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Mastrangelo M, Baglioni V. Management of Neurological Emergencies in Children: An Updated Overview. Neuropediatrics 2021; 52:242-251. [PMID: 34192789 DOI: 10.1055/s-0041-1730936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Neurological emergencies account for about one-third of the highest severity codes attributed in emergency pediatric departments. About 75% of children with acute neurological symptoms presents with seizures, headache, or other paroxysmal events. Life-threatening conditions involve a minor proportion of patients (e.g., less than 15% of children with headache and less than 5% of children with febrile seizures). This review highlights updated insights about clinical features, diagnostic workup, and therapeutic management of pediatric neurological emergencies. Particularly, details will be provided about the most recent insights about headache, febrile seizures, status epilepticus, altered levels of consciousness, acute motor impairment, acute movement disorders, and functional disorders, as well as the role of diagnostic tools (e.g., neuroimaging, lumbar puncture, and electroencephalography), in the emergency setting. Moreover, the impact of the current novel coronavirus disease2019 (COVID-19) pandemic on the evaluation of pediatric neurologic emergencies will also be analyzed.
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Affiliation(s)
- Mario Mastrangelo
- Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza Università di Roma, Rome, Italy
| | - Valentina Baglioni
- Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza Università di Roma, Rome, Italy
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26
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Abstract
The study evaluated the short-term outcome of children diagnosed with conversion disorder and compared their pre- and post-intervention psychological functioning. Fifty children consecutively diagnosed with conversion disorder over a period of one year were recruited from the pediatrics department of a tertiary care teaching hospital in North India. The adverse life events were assessed by the Life Events Scale for Indian Children, emotional and behavioral difficulties by the Childhood Psychopathology Measurement Schedule (CPMS), and adjustment by the Pre-Adolescent Adjustment Scale (PAAS). Majority of the children improved at follow up at 3 mo after initiation of treatment. In addition, total scores on the CPMS significantly declined (t = 5.12, P = 0.0001) and self-reported adjustment improved on the PAAS (t = 5.81, P = 0.0001) as compared to functioning before the initiation of therapy. Timely recognition and multi-disciplinary management can lead to successful outcome and improved functioning in most children diagnosed with conversion disorder.
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27
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Wiggins A, Court A, Sawyer SM. Somatic symptom and related disorders in a tertiary paediatric hospital: prevalence, reach and complexity. Eur J Pediatr 2021; 180:1267-1275. [PMID: 33185780 DOI: 10.1007/s00431-020-03867-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
Specialist paediatric services manage a variety of presentations of functional somatic symptoms. We aimed to describe the presentation and management of children and adolescents with somatic symptom and related disorders (SSRDs) requiring admission to a tertiary children's hospital with the objective of informing the development of a local clinical pathway. Patients admitted to any hospital department from May 2016 to November 2017 were identified through an electronic medical record (EMR)-linked diagnosis of SSRD. Each record was reviewed for demographic details and admission histories. The frequency of interspecialty consultations and multidisciplinary team (MDT) family meetings were recorded. One hundred twenty-three patients with SSRD were admitted on 203 occasions to 17 different departments. The median (range) age was 14.3 (7.3-18.3) years. Interspecialty consultations occurred in 84.6% of patients, and MDT family meetings occurred in 18.9% patients. SSRD was diagnosed as an inpatient in 79.9% patients, yet only 40.7% of patients, including those with multiple admissions, had SSRD recorded as a discharge diagnosis.Conclusion: Despite high rates of consultation with hospital teams, the frequency of MDT family meetings was low, and less than half the patients had SSRD documented at discharge. This affirms the value of developing a local clinical pathway. What is Known • Functional somatic symptoms are commonly seen in children and adolescents. • Few studies have explored the reach of functional somatic symptoms across a tertiary paediatric hospital; the majority of inpatient studies have focused on a limited set of disorders or cases referred to psychiatry departments. What is New • Symptoms that spanned multiple body systems were the most common presentation of SSRDs in admitted children and adolescents. • Somatic symptom disorders are less likely to be recorded as a discharge diagnosis compared with functional neurological symptom disorder.
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Affiliation(s)
- Aaron Wiggins
- Department of Mental Health, Royal Children's Hospital, Melbourne, Australia.
| | - Andrew Court
- Department of Mental Health, Royal Children's Hospital, Melbourne, Australia
| | - Susan M Sawyer
- Department of Adolescent Medicine, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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Ayyash HF, Ogundele MO, Lynn RM, Schumm TS, Ani C. Involvement of community paediatricians in the care of children and young people with mental health difficulties in the UK: implications for case ascertainment by child and adolescent psychiatric, and paediatric surveillance systems. BMJ Paediatr Open 2021; 5:e000713. [PMID: 33614992 PMCID: PMC7871672 DOI: 10.1136/bmjpo-2020-000713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/08/2020] [Accepted: 01/09/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To ascertain the extent to which community paediatricians are involved in the care of children with mental health conditions in order to determine which difficulties are appropriate for single or joint surveillance by the British Paediatric Surveillance Unit (BPSU) and Child and Adolescent Psychiatry Surveillance System (CAPSS). Design An online survey of the 1120 members of the British Association of Community Child Health (BACCH) working in 169 Community Child Health (CCH) services in the UK. Results A total of 245 community paediatricians responded to the survey. This represents 22% of members of BACCH but likely to have covered many of the 169 CCH units because participants could respond on behalf of other members in their unit. The survey showed that children and young people (CYP) with neurodevelopmental conditions presented more frequently to paediatrics than to Child and Adolescent Mental Health Services (CAMHS). In addition, a sizeable proportion of CYP with emotional difficulties presented to paediatricians (eg, 29.5% for anxiety/obsessive compulsive disorder (OCD), and 12.8% for depression)-mainly due to difficulty with accessing CAMHS. More than half of the community paediatricians are involved in the care of CYP with anxiety and OCD, while 32.3% are involved in the care of those with depression. Conclusion There is significant involvement of community paediatricians in the care of CYP with mental health conditions. Involvement is highest for neurodevelopmental conditions, but also significant for CYP with emotional difficulties. The implication of the findings for surveillance case ascertainment is that joint BPSU and CAPSS is recommended for surveillance studies of neurodevelopmental conditions. However, for emotional disorders, single or joint surveillance should be made based on the specific research question and the relative trade-offs between case ascertainment, and the additional cost and reporting burden of joint surveillance. Single CAPSS studies remain appropriate for psychosis and bipolar disorder.
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Affiliation(s)
- Hani F Ayyash
- Integrated Department of Paediatrics, Mid and South Essex University Hospitals Group, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
- Child and Adolescent Psychiatric Surveillance Unit, Royal College of Psychiatry, London, UK
| | - Michael Oladipo Ogundele
- Halton Community Paediatrics, Bridgewater Community Healthcare NHS Foundation Trust, Runcorn, Merseyside, UK
| | - Richard M Lynn
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
- Child and Adolescent Psychiatric Surveillance Unit, Royal College of Psychiatry, London, UK
- Institute of Child Health, University College London Research Department of Epidemiology and Public Health, London, UK
| | | | - Cornelius Ani
- Child and Adolescent Psychiatric Surveillance Unit, Royal College of Psychiatry, London, UK
- Child and Adolescent Psychiatry, Imperial College London Faculty of Medicine, London, UK
- Child and Adolescent Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, UK
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Kasia K, Nicola G, Stephen S, Blanche S. Psychologically informed physiotherapy as part of a multidisciplinary rehabilitation program for children and adolescents with functional neurological disorder: Physical and mental health outcomes. J Paediatr Child Health 2021; 57:73-79. [PMID: 32861224 DOI: 10.1111/jpc.15122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
AIM Children and adolescents with functional neurological disorder (FND) present with physical impairment and mental health comorbidities. Specialist physiotherapy programs for treating FND have been developed over the last two decades. This article reports outcome data from three cohorts of children treated with a multidisciplinary rehabilitation intervention - the Mind-Body Program - in which a psychologically informed physiotherapy intervention, known as the wellness approach to physiotherapy, was a key component. METHODS For three cohorts of children (n = 57, n = 60 and n = 25, respectively) treated in the Mind-Body Program, data about functional impairment and mental health concerns were collected at presentation and at follow-up (4 years, 12 months and 18 months, respectively). RESULTS Outcome data show that FND symptoms resolved in 54/57 (95%), 51/60 (85%) and 22/25 (88%) of children in the three cohorts, and that 31/57 (61%), 32/60 (53%) and 13/25 (52%) of children returned to full health and to full-time school attendance. Changes in Global Assessment of Function (GAF) were significant (t(54) = 21.60, P < 0.001; t(55) = 9.92, P < 0.001; t(24) = 6.51, P < 0.001). Outcomes were less favourable for children with chronic FND symptoms at presentation; those whose comorbid mental health disorders or other (comorbid) functional somatic symptoms did not resolve; and those who subsequently developed chronic mental health problems. CONCLUSIONS Implementation of a multidisciplinary rehabilitation intervention - with psychologically informed physiotherapy as one of the key treatment components - resulted in resolution of FND symptoms and return to health and well-being in the large majority of patients.
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Affiliation(s)
- Kozlowska Kasia
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, New South Wales, Australia.,The Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Gray Nicola
- Department of Physiotherapy, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Scher Stephen
- Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, New South Wales, Australia.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Savage Blanche
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Chouksey A, Pandey S. Functional Movement Disorders in Children. Front Neurol 2020; 11:570151. [PMID: 33281706 PMCID: PMC7688912 DOI: 10.3389/fneur.2020.570151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/26/2020] [Indexed: 01/28/2023] Open
Abstract
Functional movement disorders (FMDs) are not uncommon in children. The age at onset may have a bearing on the phenomenological pattern of abnormal movement, risk factors, and response to different treatment modalities in this age group. FMDs in children resemble their adult counterparts in terms of gender preponderance, but risk factors are quite different, and often influenced by cultural and demographic background. FMDs contribute to a significant proportion of acute pediatric movement disorder patients seen in emergency settings, ranging from 4.3 to 23% in different case series. The most common movement phenomenologies observed in pediatric FMDs patients are tremor, dystonia, gait disturbances, and functional tics. Various social, physical, and familial precipitating factors have been described. Common social risk factors include divorce of parents, sexual abuse, bullying at school, examination pressure, or other education-related issues, death of a close friend, relative, or family members. Physical trauma like minor head injury, immunization, tooth extraction, and tonsillectomy are also known to precipitate FMDs. The response to treatment appears to be better among pediatric patients. We aim to review FMDs in children to better understand the different aspects of their frequency, clinical features, precipitating factors, diagnosis, treatment, and outcome.
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Affiliation(s)
- Anjali Chouksey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
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31
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Eke H, Ford T, Newlove-Delgado T, Price A, Young S, Ani C, Sayal K, Lynn RM, Paul M, Janssens A. Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): findings from a British national surveillance study. Br J Psychiatry 2020; 217:616-622. [PMID: 31159893 PMCID: PMC7589988 DOI: 10.1192/bjp.2019.131] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Optimal transition from child to adult services involves continuity, joint care, planning meetings and information transfer; commissioners and service providers therefore need data on how many people require that service. Although attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood, evidence is limited on these transitions. AIMS To estimate the national incidence of young people taking medication for ADHD that require and complete transition, and to describe the proportion that experienced optimal transition. METHOD Surveillance over 12 months using the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow-up questionnaires. RESULTS Questionnaire response was 79% at baseline and 82% at follow-up. For those aged 17-19, incident rate (range adjusted for non-response) of transition need was 202-511 per 100 000 people aged 17-19 per year, with successful transition of 38-96 per 100 000 people aged 17-19 per year. Eligible young people with ADHD were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria. CONCLUSIONS As inclusion criteria required participants to be on medication, these estimates represent the lower limit of the transition need. Two critical points were apparent: referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.
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Affiliation(s)
- Helen Eke
- Postgraduate Research Fellow, University of Exeter Medical School, St. Luke's Campus, UK,Correspondence: Helen Eke, South Cloisters Rm 1.01, University of Exeter Medical School, St Luke's Campus, 79 Heavitree Road, ExeterEX1 2LU, UK.
| | - Tamsin Ford
- Professor of Child and Adolescent Psychiatry, University of Exeter Medical School, St. Luke's Campus, UK
| | - Tamsin Newlove-Delgado
- National Institute for Health Research Academic Clinical Lecturer, University of Exeter Medical School, St. Luke's Campus, UK
| | - Anna Price
- Associate Research Fellow, University of Exeter Medical School, St. Luke's Campus, UK
| | | | - Cornelius Ani
- Consultant Child and Adolescent Psychiatrist, Centre for Psychiatry, Imperial College London, UK
| | - Kapil Sayal
- Professor of Child and Adolescent Psychiatry, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham; and Professor of Child and Adolescent Psychiatry, CANDAL (Centre for ADHD and Neuro-Developmental Disorders across the Lifespan), Institute of Mental Health, UK
| | - Richard M. Lynn
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, UK
| | - Moli Paul
- Consultant Child and Adolescent Psychiatrist, Coventry and Warwickshire Partnership Trust, UK
| | - Astrid Janssens
- Associate Professor, Department of Public Health, University of Southern Denmark, Denmark; and Honorary Associate Professor, University of Exeter Medical School, St. Luke's Campus, UK
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Hansen AS, Rask CU, Rodrigo-Domingo M, Pristed SG, Christensen J, Nielsen RE. Incidence rates and characteristics of pediatric onset psychogenic nonepileptic seizures. Pediatr Res 2020; 88:796-803. [PMID: 32392575 DOI: 10.1038/s41390-020-0945-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pediatric onset psychogenic nonepileptic seizures (PNES) is a highly disabling disorder and potentially misdiagnosed as epilepsy. Still, knowledge regarding PNES in children and adolescents is limited and data on both incidence and characteristics are scarce. This study investigated the incidence rate (IR) and clinical characteristics of pediatric onset PNES, including possible differences when having comorbid epilepsy. METHODS A population-based study of children and adolescents aged 5-17 years with an incident diagnosis of PNES in the Danish healthcare registries between 1996 and 2014. In total, 386 children and adolescents were included after assessment of diagnostic validity using medical record data. RESULTS The IR increased during the study period with the maximum IR observed in 2014 (7.4 per 100,000 person-years). A history of both neurologic and psychiatric problems as well as negative life events was identified. Comorbid epilepsy was confirmed for 55 cases (14.2%) and was associated with intellectual disabilities, school support and prolonged delay in PNES diagnosis. CONCLUSIONS PNES are increasingly diagnosed in children and adolescents, and the clinical profile of both neurologic and psychiatric health problems underscores the need for collaborative pediatric and mental healthcare. These findings provide important information for future healthcare planning in this area. IMPACT This nationwide study is the first to report population-based incidence rates of pediatric onset PNES documenting markedly increasing incidence rates between 1996 and 2014. A history of both neurologic and psychiatric problems as well as negative life events was identified for pediatric onset PNES. Comorbid epileptic seizures were associated with intellectual disabilities, school support and prolonged delay in PNES diagnosis. The clinical profile of both neurologic and psychiatric health problems underscores the need for collaborative pediatric and mental healthcare. The increasing number of children and adolescents diagnosed with PNES is important information for future healthcare planning in this area.
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Affiliation(s)
- Anne S Hansen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Charlotte U Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Rodrigo-Domingo
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Sofie G Pristed
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - René E Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Functional neurological movements in children: Management with a psychological approach. Eur J Paediatr Neurol 2020; 28:101-109. [PMID: 32800685 DOI: 10.1016/j.ejpn.2020.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 07/19/2020] [Indexed: 01/15/2023]
Abstract
AIM To develop a cognitive behavioural treatment (CBT) approach that included novel attention training components to support symptom management in children with a primary diagnosis of Functional Movement Disorder (FMD). METHOD Eighteen children (9 male and 9 female) with a mean age of 13 years (sd = 2.46, range 10-18 years) were assessed and completed CBT with novel attention training components. Treatment outcomes were measured using the Child Global Assessment Scale (CGAS) which was administered at baseline and post-treatment. RESULTS Scores on the CGAS improved significantly post-treatment (p < 0.001) with all participants showing significant change in functioning on the basis of the Reliable Change Index (RCI), with clinically significant change across classification boundaries. INTERPRETATION This case series provides support for the use of CBT with attention training components for the management of FMD. Larger trials are necessary to identify which individual treatment components are most effective and to better understand and quantify response to treatment. Future clinical treatment studies would benefit from the inclusion of objective measures of interoception and attentional focus.
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Functional Neurological Symptom Disorder in Children and Adolescents within Medical Settings. J Clin Psychol Med Settings 2020; 28:90-101. [DOI: 10.1007/s10880-020-09736-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Herskovic V, Matamala M. Somatización, ansiedad y depresión en niños y adolescentes. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Raper J, Currigan V, Fothergill S, Stone J, Forsyth RJ. Long-term outcomes of functional neurological disorder in children. Arch Dis Child 2019; 104:1155-1160. [PMID: 31326916 DOI: 10.1136/archdischild-2018-316519] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To establish the incidence and long-term outcomes (up to 21 years) of children presenting to a University hospital paediatric neurology service with symptoms due to functional neurological disorder (FND) with particular reference to occurrence of FND or similar symptoms in adulthood. METHODS Retrospective chart review to determine characteristics of the original paediatric FND presentation plus record-linkage with providers of Child and Adolescent Mental Health Services. Chart review of adult medical records for documentation of functional symptoms in adulthood. RESULTS 124 individuals (56% female) met entry criteria. The most common presentations were seizures (18%), sensory loss (18%) and motor symptoms (16%). Frequency gradually increased with age of onset with an incidence in paediatric neurological services of 6 per 100 000 children under 16. In up to 21 years' follow-up (median 8.3 years), 114/124 attained their 16th birthdays by the study census date and were thus eligible for inclusion in an analysis of symptom persistence/recurrence in adulthood. 26/114 (23%) showed evidence of FND in adulthood of sufficient significance to be recorded in medical records. CONCLUSION Paediatric FND is commoner than previous estimates. Even in this selected population of children reaching specialist paediatric neurology services, a high long-term remission rate is observed.
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Affiliation(s)
- Joseph Raper
- Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Victoria Currigan
- Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sarah Fothergill
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Rob J Forsyth
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Samuels A, Tuvia T, Patterson D, Briklin O, Shaffer S, Walker A. Characteristics of Conversion Disorder in an Urban Academic Children's Medical Center. Clin Pediatr (Phila) 2019; 58:1250-1254. [PMID: 31267759 DOI: 10.1177/0009922819857541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Literature on childhood conversion disorder (CD) is sparse and is mostly limited to the outpatient population. Method. Our study retrospectively examines the characteristics of childhood CD in 42 children and adolescents seen by the psychiatric consultation-liaison service in an urban academic medical center with a large minority population. Results. CD accounted for 11% of our consultations. The majority of patients were female adolescents, but in the younger cohort, the male-to-female ratio equalized. Other somatic symptoms and additional psychiatric diagnoses were common, anxiety disorders in particular. Antecedent stressors were identified in 95% of patients, most commonly related to family stressors. Recent or remote history of abuse was rare. Neurological presentations were complex, with almost half of the patients presenting with multiple distinct neurological symptoms. Hyperkinetic symptoms were more common than hypokinetic symptoms, and paroxysmal symptoms were more common than non-paroxysmal. No distress (la belle indifference) was found in only 25% of patients and about half of patients had no socio-academic impairment. High resource utilization was noted based on multiple specialist consultants, diagnostic studies, and length of stay. Conclusion. Much of our data confirms previous findings and contributes to what is becoming a more robust characterization of this population.
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Affiliation(s)
- Ayol Samuels
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Tali Tuvia
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | | | - Olga Briklin
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Scott Shaffer
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Audrey Walker
- Montefiore Hospital and Medical Center, Bronx, NY, USA
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Eke H, Janssens A, Downs J, Lynn RM, Ani C, Ford T. How to measure the need for transition to adult services among young people with Attention Deficit Hyperactivity Disorder (ADHD): a comparison of surveillance versus case note review methods. BMC Med Res Methodol 2019; 19:179. [PMID: 31429715 PMCID: PMC6700822 DOI: 10.1186/s12874-019-0820-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/13/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Health services have not provided adequate support for young people with long term health conditions to transfer from child to adult services. National Institute of Health and Care (NICE) guidance on transition has been issued to address these gaps. However, data are often sparse about the number of young adults who might need to transition. Using Attention Deficit Hyperactivity Disorder (ADHD) as an exemplar, this study used an existing surveillance system and a case note review to capture the incidence of the transition process, and compared and contrasted the findings. METHODS The Child and Adolescent Psychiatry Surveillance System (CAPSS) was used to estimate the incident transition of young people with Attention Deficit Hyperactivity Disorder (ADHD) from child to adult services. This involves consultant child and adolescent psychiatrists from the United Kingdom (UK) and Republic of Ireland (ROI) reporting relevant young people as they are seen in clinics. In parallel, a case note review was conducted using the Maudsley Biomedical Research Centre (BRC) Clinical Records Interactive Search (CRIS). The study period ran for twelve months with a nine month follow up to see how the transition proceeded. RESULTS CRIS identified 76 cases in the study period, compared to 18 identified using surveillance via CAPSS. Methodological issues were experienced using both methods. Surveillance issues; eligibility criteria confusion, reporting errors, incomplete questionnaires, difficulties contacting clinicians, and surveillance systems do not cover non-doctors and psychiatrists who are not consultants. Case note review issues using CRIS included the need for researchers to interpret clinical notes, the availability and completeness of data in the notes, and data limited to the catchment of one particular mental health trust. CONCLUSIONS Both methods demonstrate strengths and weaknesses; the combination of both methods in the absence of strong routinely collected data, allowed a more robust estimate of the level of need for service planning and commissioning.
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Affiliation(s)
- Helen Eke
- University of Exeter Medical School, South Cloisters 1.01, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Astrid Janssens
- University of Exeter Medical School, South Cloisters 1.01, St Luke’s Campus, Exeter, EX1 2LU UK
- User Perspectives, University of Southern Denmark, DK-5000 Odense C, Denmark
| | - Johnny Downs
- Kings College London, De Crespigny Park, Denmark Hill, London SE5 8AF UK
| | - Richard M. Lynn
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, 5-11 Theobalds Rd, London, WC1X 8SH UK
| | - Cornelius Ani
- Child and Adolescent Psychiatry Surveillance System, London, UK
- Surrey & Borders Partnership NHS Foundation Trust, Redhill, UK
- Centre for Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN UK
| | - Tamsin Ford
- University of Exeter Medical School, South Cloisters 1.01, St Luke’s Campus, Exeter, EX1 2LU UK
- Child and Adolescent Psychiatry Surveillance System, London, UK
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Murgai RR, VandenBerg C, Stevanovic M, Lightdale-Miric N. Upper extremity conversion disorder in children. J Shoulder Elbow Surg 2019; 28:e175-e181. [PMID: 30685281 DOI: 10.1016/j.jse.2018.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Conversion disorder in children presents a challenge to orthopedic surgeons. The condition is frequently associated with unnecessary diagnostic tests, treatments, and cost. The purpose of this study was to report a series of children with upper extremity conversion disorder to raise awareness for this uncommon condition and to assist with its diagnosis and management. METHODS A retrospective review was conducted of 4 pediatric patients with upper extremity conversion disorder at a tertiary pediatric hospital from 2015 to 2017. Medical records were reviewed for patient demographics, including psychiatric history, clinical findings, diagnostic studies, treatment, and cost of care. RESULTS Patients presented with upper extremity muscle stiffness, unremitting dysmorphic muscle spasms, weakness, pain, very limited shoulder range of motion, and complaints of recurrent shoulder dislocations. All patients had been evaluated by multiple specialists and had an extensive prior diagnostic workup that was inconclusive. Two patients had a history of prior psychiatric illness and suicidal ideation, and all patients expressed despair and depression. All patients had normal physical examination findings under anesthesia. Two patients with muscle stiffness were treated with botulism injections and improved their shoulder range of motion. The average total charge for care since presentation was $42,729. CONCLUSIONS Conversion disorder should be considered in patients with an extensive prior diagnostic workup, deficits inconsistent with anatomic patterns or imaging findings, and a history of prior psychiatric illness. Examination under anesthesia is a successful diagnostic approach in children with suspected conversion disorder.
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Affiliation(s)
- Rajan R Murgai
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Curtis VandenBerg
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Milan Stevanovic
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Nina Lightdale-Miric
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
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Zanzmera P, Sharma A, Bhatt K, Patel T, Luhar M, Modi A, Jani V. Can short-term video-EEG substitute long-term video-EEG monitoring in psychogenic nonepileptic seizures? A prospective observational study. Epilepsy Behav 2019; 94:258-263. [PMID: 30981120 DOI: 10.1016/j.yebeh.2019.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES), the commonest nonepileptic event, represent 20-30% of drug-resistant epilepsy. Correct identification of PNES avoids unnecessary hospitalization and exposure of antiepileptic drugs (AEDs), and helps implement appropriate psychological treatment. Long-term video-electroencephalography (LTVEEG) is the gold standard test to diagnose PNES. However, in a poor-resource country like India, hypothetically, short-term video-electroencephalography (STVEEG) may substitute it, as its usefulness is established in attack disorders. OBJECTIVE The objective of this study was to evaluate effectiveness of STVEEG in PNES and to look into their clinical profile and outcome. DESIGN/METHODS Consecutive cases of PNES diagnosed with STVEEG or LTVEEG during 2015-16 (two years) were enrolled. All cases were followed for 12 months or more. Detailed clinical evaluation was done including demography, semiology, coexisting anxiety/depressive disorders, and seizure frequency at time of first diagnosis and follow-up. The PNES were classified as Type I hypermotor, type II hypomotor, and type III unclassified/mixed. Favorable outcome was defined as seizure freedom or >50% reduction in seizure frequency while unfavorable outcome was defined as <50% reduction in seizure frequency on follow-up at 6 and 12 months. RESULTS Among 57 patients with PNES [median age of onset 24 years (10-69 years), F:M ratio = 7:3)], STVEEG ± induction could record event(s) in 80.7% while the rest required LTVEEG to confirm diagnosis. Among 82 events analyzed, the mean ± 2 standard deviation (SD) duration of events was 5'14″ ± 13'4″. Sixty-two (75.6%) and 10 (12.1%) events were hypermotor and hypomotor respectively, while 10 (12.1%) were unclassified/mixed. Forty-five (79%) patients had pure PNES, while 12 (21%) had coexistent epilepsy. Forty-nine (86%) and 54 (94.7%) patients had statistically significant reduction of seizure frequency (favorable outcome), at 6 and 12 months of follow-up respectively, while the rest had an unfavorable outcome. CONCLUSIONS The STVEEG has a remarkably good yield in diagnosing PNES, and it may be used when LTVEEG is not feasible. However, further studies are needed to show if it can substitute LTVEEG in PNES.
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Affiliation(s)
- Paresh Zanzmera
- Department of Neurology, Government Medical College, Surat, India.
| | - Arvind Sharma
- Department of Medicine, Government Medical College, Surat, India
| | | | - Tinkal Patel
- Department of Medicine, Government Medical College, Surat, India
| | - Mehul Luhar
- Department of Psychiatry, Government Medical College, Surat, India
| | - Anjali Modi
- Department of Preventive and Social Medicine, Government Medical College, Surat, India
| | - Vipul Jani
- Department of Psychiatry, Government Medical College, Surat, India
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Abstract
Although children with dissociative disorders (DD) are referred to mental health inpatient units, no research exists to endorse this. We studied the outcomes of patients with DD over a 5-year period on a national inpatient unit for children up to 12 years of age. Demographic, clinical, and satisfaction data were collected and compared with the data of other inpatients not having DD. Eight patients were identified, of whom six were female. All had several comorbidities. Mean Children's Global Assessment Scale scores improved from admission to discharge (from 31 to 61, respectively). Admissions in DD were longer by 53 days (p = 0.059), and parents were statistically less satisfied about professionals' ability to listen to worries they may have about their child (p = 0.049). Referrers should expect children with DD to respond as well to inpatient interventions as those with other diagnoses but potentially with marginally longer admissions and lower parental satisfaction.
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Watson C, Sivaswamy L, Agarwal R, Du W, Agarwal R. Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children's Hospital. J Child Neurol 2019; 34:325-331. [PMID: 30819032 DOI: 10.1177/0883073819830193] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the presenting symptoms and short-term outcomes of children diagnosed with functional neurologic symptom disorder and to compare the demographic and clinical characteristics of children who received neurodiagnostic testing to those who did not. STUDY DESIGN Single center, retrospective review of 222 children who presented to the emergency department of a children's hospital, and diagnosed with functional neurologic symptom disorder, between 2010 and 2015. RESULTS Out of 222 visits (females = 156, African Americans = 130, mean age = 13.9 years), neurodiagnostic tests were performed in 102/222 (46%) visits. The most commonly performed investigations were magnetic resonance imaging (MRI) of brain (n = 37) and electroencephalogram (EEG) (n = 56) and were noted to be unremarkable in all instances. Neurodiagnostic tests were more likely to be performed in patients who (1) were non-African American (54% vs 40%; P = .03), (2) presented with new-onset symptoms (55% vs 31%; P < .01), (3) underwent hospitalization (61% vs 17%; P < .01), and (4) were evaluated by a neurologist (59% vs 9%; P < .01) or a psychiatrist (58% vs 28%; P < .01). Common clinical presentations included seizurelike or strokelike symptoms. Short-term follow-up was possible in 20%, with an alternate diagnosis of syncope, noted in only 1 child. CONCLUSIONS Most children who presented with a functional neurologic symptom disorder in our study were noted to have seizurelike or strokelike presentations and were adolescent females. Caucasians were more likely to undergo neurodiagnostic investigations. Radiologic and neurophysiological tests were more commonly performed when neurology and psychiatry consultations were sought. Such investigations had low diagnostic utility.
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Affiliation(s)
- Carla Watson
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Roshani Agarwal
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,4 Divisions of Hospital Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Wei Du
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Rajkumar Agarwal
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
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43
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Kozlowska K, Chung J, Cruickshank B, McLean L, Scher S, Dale RC, Mohammad SS, Singh-Grewal D, Prabhuswamy MY, Patrick E. Blood CRP levels are elevated in children and adolescents with functional neurological symptom disorder. Eur Child Adolesc Psychiatry 2019; 28:491-504. [PMID: 30143887 DOI: 10.1007/s00787-018-1212-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/03/2018] [Indexed: 01/09/2023]
Abstract
There is accumulating evidence that patients with functional neurological symptom disorder (FND) show activation of multiple components of the stress system-the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and brain regions involved in arousal- and emotion-processing. This study aims to examine whether the immune-inflammatory component of the stress system is also activated. C-reactive protein (CRP) blood titre levels were measured in 79 children and adolescents with FND. CRP values ≥ 2 mg/L suggest low-grade inflammation. CRP values > 10 mg/L suggest a disease process. Sixty-six percent of subjects (n = 52) had CRP titres ≥ 2 mg/L. The upward shift in the distribution of CRP levels suggested low-grade inflammation (median CRP concentration was 4.60 mg/L, with 75th and 90th percentiles of 6.1 and 10.3 mg/L, respectively). Elevated CRP titres were not explained by sex, pubertal status, BMI, or medical factors. Confounder analyses suggested that history of maltreatment (χ2 = 2.802, df = 1, p = 0.094, φ = 0.190; β = 2.823, p = 0.04) and a diagnosis of anxiety (χ2 = 2.731, df = 1, p = 0.098, φ = 0.187; β = 4.520, p = 0.061) contributed to elevated CRP levels. Future research will need to identify the origins and locations of immune cell activation and the pathways and systems contributing to their activation and modulation. Because functional activity in neurons and glial cells-the brain's innate effector immune cells-is tightly coupled, our finding of elevated CRP titres suggests activation of the immune-inflammatory component of the brain's stress system. A more direct examination of inflammation-related molecules in the brain will help clarify the role of immune-inflammatory processes in FND.
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Affiliation(s)
- Kasia Kozlowska
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia. .,Brain Dynamics Centre, Westmead Institute of Medical Research, Westmead, NSW, Australia. .,Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.
| | - Jason Chung
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia
| | - Bronya Cruickshank
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Loyola McLean
- Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Building 112, Cumberland Hospital Campus, Parramatta BC, Locked Bag 7118, Parramatta, NSW, 2124, Australia.,Brain and Mind Centre, and Discipline of Psychiatry, University of Sydney Medical School, Sydney, NSW, Australia
| | - Stephen Scher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,McLean Hospital, Belmont, MA, USA.,Discipline of Psychiatry, University of Sydney Medical School, Sydney, NSW, Australia
| | - Russell C Dale
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Movement Disorder and Clinical Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Shekeeb S Mohammad
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Davinder Singh-Grewal
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Department of Rheumatology, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Discipline of Child and Maternal Health, University of New South Wales, Sydney, NSW, Australia
| | - Mukesh Yajaman Prabhuswamy
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Ellis Patrick
- School of Mathematics and Statistics, University of Sydney, F07 - Carslaw Building, Sydney, NSW, 2006, Australia.,Westmead Institute for Medical Research, Sydney, NSW, Australia
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McFarlane FA, Allcott-Watson H, Hadji-Michael M, McAllister E, Stark D, Reilly C, Bennett SD, McWillliams A, Heyman I. Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series. Eur J Paediatr Neurol 2019; 23:317-328. [PMID: 30594458 DOI: 10.1016/j.ejpn.2018.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/09/2018] [Accepted: 12/09/2018] [Indexed: 11/19/2022]
Abstract
AIM To describe a cognitive-behavioural treatment and clinical outcomes in a series of children with functional neurological symptoms (FNS). METHOD Thirty-six children with FNS were assessed and of these twenty-two (13 male, 9 female) with a mean age 14.5 years (SD = 2.6, range 6-17 years) completed treatment with cognitive behaviour therapy embedded in routine child and adolescent clinical/systemic practice. Treatment outcomes were measured at baseline and post-intervention on the Child Global Assessment Scale (CGAS), Strengths and Difficulties Questionnaire (SDQ), Goal Based Outcomes (GBO) and Revised Child Anxiety and Depression Scale (RCADS). RESULTS Scores on the CGAS improved significantly post-intervention (p < 0.001) with 82% of participants showing reliable change. Individualised goals (GBO) also showed clinically meaningful gains. Standard measures of emotional and behavioural symptoms (SDQ and RCADS) did not correlate well with clinical diagnoses, were usually subthreshold at baseline, and did not show significant improvement post-intervention. INTERPRETATION The outcome of this pilot study suggests that CBT can be effective in the rehabilitation of young patients with FNS. Detection of common comorbid psychiatric disorders was not assisted by use of standardised measures, although most participants were clinically anxious or depressed. More research is needed to understand why children with FNS and their parents may not endorse mental health symptoms on questionnaires, and to further evaluate interventions within randomised controlled trials.
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Affiliation(s)
- Fiona A McFarlane
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK
| | - Hannah Allcott-Watson
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK
| | - Maria Hadji-Michael
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK
| | - Eve McAllister
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK
| | - Daniel Stark
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK
| | - Colin Reilly
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK; Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK
| | - Sophie D Bennett
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK
| | - Andrew McWillliams
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, 16 de Crespigny Park, London, SE5 8AF, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK.
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45
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Wilkinson-Smith A, Greenberg B, Keech A. The princess and the p-value: A case report of suspected autoimmune encephalitis and functional neurological disorder in a pediatric patient. APPLIED NEUROPSYCHOLOGY-CHILD 2018; 9:13-20. [DOI: 10.1080/21622965.2018.1501373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alison Wilkinson-Smith
- Department of Psychiatry, Children’s Health Children’s Medical Center, Dallas, Texas, USA
| | - Benjamin Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Audrey Keech
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Nielsen ES, Wichaidit BT, Østergaard JR, Rask CU. Paediatricians' attitudes to and management of functional seizures in children. Eur J Paediatr Neurol 2018; 22:774-781. [PMID: 29871800 DOI: 10.1016/j.ejpn.2018.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/04/2018] [Accepted: 05/20/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To explore paediatricians' attitudes to and treatment practice for children with functional seizures (FS). METHODS In a nationwide survey, all 64 Danish neuro-paediatricians and social paediatricians were invited to complete a structured questionnaire encompassing FS-related issues that included beliefs and attitudes about aetiology and diagnostic assessment, current strategies for management, experienced need for clinical guidelines and better treatment options. RESULTS A total of 61 paediatricians (95%) participated in the study. Nearly half (46%) had seen more than 30 children with FS during their career. Most (65%) believed in a primarily psychogenic aetiology. More than half (57%) stated that they could make the diagnosis by solely observing a seizure, and 18% indicated the children faked their symptoms. The paediatricians' responses to these issues did not significantly vary according to their level of clinical experience. Furthermore, the majority (78%) expressed a need for clinical guidelines, and only 13% rated existing treatment options as sufficient. Collaborative care between different specialties or management in a child and adolescent mental health services (CAMHS) setting was seen as the best model for treatment. However, only 23% reported often referring these children to CAMHS after making the diagnosis. CONCLUSION The findings suggest that introduction of clinical guidelines in this area is highly needed. Such guidelines could promote more formal training of paediatricians in understanding and assessing FS and increased collaboration between paediatrics and CAMHS regarding care for children with this challenging and potentially costly and disabling disorder.
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Affiliation(s)
| | - Bianca Taaning Wichaidit
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | | | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark; Child and Adolescent Psychiatric Centre, Aarhus University Hospital, Risskov, Denmark
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Heimann P, Herpertz-Dahlmann B, Buning J, Wagner N, Stollbrink-Peschgens C, Dempfle A, von Polier GG. Somatic symptom and related disorders in children and adolescents: evaluation of a naturalistic inpatient multidisciplinary treatment. Child Adolesc Psychiatry Ment Health 2018; 12:34. [PMID: 29988308 PMCID: PMC6022439 DOI: 10.1186/s13034-018-0239-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/23/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND This naturalistic study assesses the effectiveness of inpatient multidisciplinary treatment of children and adolescents with somatic symptom disorders (SSD) and investigates the role of pain coping strategies and psychiatric comorbidity (anxiety, depression). METHODS Sixty children and adolescents (mean age 14.4 years) with SSD who underwent inpatient multidisciplinary treatment were assessed regarding their school attendance, levels of discomfort, coping strategies and psychiatric comorbidity (depression, anxiety) at pretreatment, discharge and 6 months following treatment. RESULTS At discharge, the children and adolescents reported improvements in their level of discomfort, psychiatric comorbidities (anxiety, depression) and pain coping strategies, with medium to large effect sizes. Six months following treatment, the improvements remained stable, including significantly higher school attendance rates (d = 1.6; p < 0.01). Improvement in pain coping was associated with increased school attendance. CONCLUSION Inpatient multidisciplinary treatment is effective in reducing levels of discomfort, psychiatric comorbidity (anxiety, depression), and school absence and in improving coping strategies.
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Affiliation(s)
- Pola Heimann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Jonas Buning
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Norbert Wagner
- Department of Pediatrics, RWTH Aachen University, Aachen, Germany
| | | | - Astrid Dempfle
- Department of Medical Informatics and Statistic, University Schleswig-Holstein, Kiel, Germany
| | - Georg G. von Polier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
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Caulley L, Kohlert S, Gandy H, Olds J, Bromwich M. When symptoms don't fit: a case series of conversion disorder in the pediatric otolaryngology practice. J Otolaryngol Head Neck Surg 2018; 47:39. [PMID: 29843801 PMCID: PMC5975680 DOI: 10.1186/s40463-018-0286-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Conversion disorder refers to functional bodily impairments that can be precipitated by high stress situations including trauma and surgery. Symptoms of conversion disorder may mimic or complicate otolaryngology diseases in the pediatric population. Case presentation In this report, the authors describe 3 cases of conversion disorder that presented to a pediatric otolaryngology-head and neck surgery practice. This report highlights a unique population of patients who have not previously been investigated. The clinical presentation and management of these cases are discussed in detail. Non-organic otolaryngology symptoms of conversion disorder in the pediatric population are reviewed. In addition, we discuss the challenges faced by clinicians in appropriately identifying and treating these patients and present an approach to management of their care. Conclusion In this report, the authors highlight the importance of considering psychogenic illnesses in patients with atypical clinical presentations of otolaryngology disorders.
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Affiliation(s)
- Lisa Caulley
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Otolaryngology - Head and Neck Surgery, Children's Hospital of Eastern Ontario, 400 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Scott Kohlert
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Otolaryngology - Head and Neck Surgery, Children's Hospital of Eastern Ontario, 400 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Hazen Gandy
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Janet Olds
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Psychology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Matthew Bromwich
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, ON, Canada. .,Division of Otolaryngology - Head and Neck Surgery, Children's Hospital of Eastern Ontario, 400 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
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Kozlowska K, Spooner CJ, Palmer DM, Harris A, Korgaonkar MS, Scher S, Williams LM. "Motoring in idle": The default mode and somatomotor networks are overactive in children and adolescents with functional neurological symptoms. Neuroimage Clin 2018; 18:730-743. [PMID: 29876262 PMCID: PMC5987846 DOI: 10.1016/j.nicl.2018.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 12/20/2022]
Abstract
Objective Children and adolescents with functional neurological symptom disorder (FND) present with diverse neurological symptoms not explained by a disease process. Functional neurological symptoms have been conceptualized as somatoform dissociation, a disruption of the brain's intrinsic organization and reversion to a more primitive level of function. We used EEG to investigate neural function and functional brain organization in children/adolescents with FND. Method EEG was recorded in the resting eyes-open condition in 57 patients (aged 8.5-18 years) and 57 age- and sex-matched healthy controls. Using a topographical map, EEG power data were quantified for regions of interest that define the default mode network (DMN), salience network, and somatomotor network. Source localization was examined using low-resolution brain electromagnetic tomography (LORETA). The contributions of chronic pain and arousal as moderators of differences in EEG power were also examined. Results Children/adolescents with FND had excessive theta and delta power in electrode clusters corresponding to the DMN-both anteriorly (dorsomedial prefrontal cortex [dmFPC]) and posteriorly (posterior cingulate cortex [PCC], precuneus, and lateral parietal cortex)-and in the premotor/supplementary motor area (SMA) region. There was a trend toward increased theta and delta power in the salience network. LORETA showed activation across all three networks in all power bands and localized neural sources to the dorsal anterior cingulate cortex/dmPFC, mid cingulate cortex, PCC/precuneus, and SMA. Pain and arousal contributed to slow wave power increases in all three networks. Conclusions These findings suggest that children and adolescents with FND are characterized by overactivation of intrinsic resting brain networks involved in threat detection, energy regulation, and preparation for action.
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Affiliation(s)
- Kasia Kozlowska
- The Children's Hospital at Westmead, Psychological Medicine, Locked Bag 4001, Westmead, NSW 2145, Australia; The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | | | - Donna M Palmer
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | - Anthony Harris
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia; Westmead Hospital Psychiatry Department, Darcy Rd, Westmead, NSW 2145, Australia.
| | - Mayuresh S Korgaonkar
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | - Stephen Scher
- The University of Sydney, Sydney, Australia; Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA.
| | - Leanne M Williams
- Psychiatry and Behavioral Sciences, Stanford University, VA Palo Alto (Sierra-Pacific MIRECC) 401 Quarry Rd, United States.
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50
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Cheng Q, Xie L, Hu Y, Hu J, Gao W, Lv Y, Xu Y. Gender differences in the prevalence and impact factors of hysterical tendencies in adolescents from three eastern Chinese provinces. Environ Health Prev Med 2018; 23:5. [PMID: 29415649 PMCID: PMC5803911 DOI: 10.1186/s12199-018-0695-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have attempted to compare the differences in the prevalence and impact factors of hysterical tendencies (HTs) in adolescents. Thus, the aim of this study was to examine gender differences in the prevalence and impact factors of adolescents' HTs across three eastern Chinese provinces (Anhui, Jiangsu, and Zhejiang). METHODS A multicenter, school-based, cross-sectional study was conducted in three provinces (Anhui, Jiangsu, and Zhejiang) in China in 2014. The sample included 10,131 middle-school students aged 13-18 years who were randomly selected using a multiphase, stratified, cluster sampling technique. A two-stage appraisal procedure was used to determine the adolescents' HTs. We also designed a multicenter, school-based, case control (1329 cases with 2661 control individuals) study to collect data on the common factors affecting this population using a common protocol and questionnaire. RESULTS An overall positive rate of HTs among adolescents across the three eastern Chinese provinces studied was found at 13.1% (95% confidence interval (CI) 12.5-13.8%), at 14.5% (95% CI 13.3-15.7%) for females, and at 12.2% (95% CI 11.1-13.4%) for males. Gender-stratified, multiple conditional regression analyses revealed that superstitious beliefs pertaining to life, somatotype, teacher-student satisfaction, and family achievement orientation were significantly linked to HTs only in males, while left-behind adolescents, emotional and social adaptation, teacher-student support, family cohesion, and the Hospital Anxiety and Depression Scale - depression scores were significantly associated with female HTs only. The models indicated that of all the independent variables studied, family medical history was the strongest impact factor for both male HTs (adjusted matched odds ratio (amOR) = 2.92, 95% CI = 1.84-4.86) and female HTs (amOR = 2.74, 95% CI = 1.59-4.98). CONCLUSIONS HTs are prevalent among adolescents in the three eastern Chinese provinces studied. Gender differences in the prevalence and impact factors of HTs are significant in adolescents, and HTs seem to affect more females than males. Therefore, sex-specific intervention programs against HTs in adolescents should be considered to reduce HT prevalence in adolescents by modifying influential social, school, and family factors.
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Affiliation(s)
- Qinglin Cheng
- Department of Adolescents and Children’s Health, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123 China
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Li Xie
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yunkai Hu
- Fuyang New Rural Cooperative Medical Office, Fuyang, China
| | - Jinfeng Hu
- Shangcheng District Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Gao
- Mingguang Health and Family Planning Commission, Mingguang, China
| | - Yongxiang Lv
- Jin’an District Center for Disease Control and Prevention, Lu’an, China
| | - Yong Xu
- Department of Adolescents and Children’s Health, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123 China
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