Characterization of the Epidemiologic Profile and Non-pharmacologic Therapy Utilization Profile of Functional Neurologic Disorder in Patients with Migraine from a Multicenter Electronic Medical Record Database
Ethan J. Le1, Victor S. Wang2, Mario F. P. Peres3, Hsiangkuo Yuan2
1Sidney Kimmel Medical College, 2Jefferson Headache Center, 3Institute of Psychiatry, University of São Paulo
Objective:

To compare the epidemiologic and non-pharmacologic therapy utilization profile of migraine patients with and without functional neurologic disorders (FND). To understand the impact of non-pharmacologic therapies on healthcare utilization patterns in patients with migraine and FND.

Background:

FND is an understudied neurologic condition affecting both motor and sensory functions without an attributable organic explanatory diagnosis. The relationship between FND and migraine remains limited.

Design/Methods:

Using the TriNetX database, cohorts of migraine patients with FND with motor weakness (MwF, ICD10 G43 with F44.4) and migraine patients without FND with motor weakness (MwoF) were evaluated. Information was obtained regarding patient demographics, medical comorbidities, medications, treatment outcomes [emergency department usage (EDU) and inpatient hospitalizations (IH)], and non-pharmacologic therapy services [physical therapy (PT) and psychotherapy]. Propensity score-matched cohorts of MwF and MwoF with standardized characteristics (demographics, medications, and PT) were created to compare treatment outcomes.

Results:

From a network population of 130,161,553 patients, we identified a total of 2,687,354 (prevalence 2.06%) with a diagnosis of migraine, of which 14,182 (0.53%, prevalence 0.01%) were MwF. For MwF compared to MwoF, the mean age was 40.1±16.5 vs 39.0±17.9, female-to-male ratio was 4.9 vs 3.3, 16.2% vs 11.4% were black. Treatment profiles of MwF vs MwoF include transient ischemic attack (11.6% vs 3.3%), cerebral infarction (9.4% vs 1.3%), PT (17.8% vs 9.2%), psychotherapy (10.5% vs 3.3%), EDU (24.6% vs 19.0%) and IH (22.7% vs 16.0%). All comparisons were statistically significant p<0.0001. Post-propensity score matching of MwF compared to MwoF revealed increased EDU (24.6% vs 20.9%, Risk Ratio (RR) 1.174, 95% CI [1.104, 1.248]) and IH (22.7% vs 17.2%, RR 1.313, [1.225, 1.409]).

Conclusions:

MwF patients have a significantly higher proportion of black race, cerebrovascular diagnoses, non-pharmacologic therapy utilization, and use of hospital emergency and inpatient resources.

10.1212/WNL.0000000000205152