Associated Medical Factors as Predictors of Functional Neurological Disorders: A Retrospective Cohort Study
James Kelbert1, Cherry Barragan1, Naria Quazi1, Rachel Schuurs1, Nicole Varda1, Joshua Tobin2, Robin Garrett3, Alan Wang4, Ganesh Murthy5
1University of Arizona, College of Medicine- Phoenix, 2Banner University Medical Center Neurosciences Institute, 3Banner Health Neurosciences, 4Banner University Medical Center - Phoenix, 5Banner University Medical Center- Phoenix
Objective:
To assess whether stated allergies predict the likelihood of FND.
Background:
Functional neurological disorders (FNDs) involve perturbations of the functional brain networks instead of its structural abnormalities. While modern science better identifies FNDs, prompt diagnosis and treatment remain challenging, increasing healthcare system costs. One potential solution to improving the speed and efficiency of diagnosis involves identifying associated factors such as underlying comorbidities, gender, allergy lists and number of medications.
Design/Methods:
A retrospective chart review of a single level 4 epilepsy center was conducted involving patients assessed in the epilepsy monitoring unit (EMU) from January 2014 to January 2024, and who were definitively diagnosed with epilepsy or psychogenic non-epileptic seizure during their EMU stay. Multivariate logistic regressions were used controlling for variables such as allergies (both medication and non-medication), number of medications, gender and age. Statistical significance was determined using Wald’s test and the threshold was determined with max kappa model predictions.
Results:
A total of 250 patients (99 FND and 151 epilepsy patients) were included. The mean number of total allergies for all patients was 2.07, with epilepsy patients averaging 1.13 (range: 0 to 10), and FND patients averaging 3.48 (range: 0 to 26). Regression models showed an adjusted odds ratio of 1.43 [1.24, 1.65] for total allergies (p<0.001), 1.55 [0.85, 2.02] for female gender (p=0.15), 1.01 [0.99, 1.03] for age (p=0.19), and 1.03 [0.98, 1.07] for number of medications (p=0.25). The adjusted ratio was 1.42 [1.20, 1.68] (p<0.001) for medication allergies alone with the adjusted ratio for non-medication allergies alone was 1.62 [1.24, 2.15] (p<0.001).
Conclusions:
The number of total, medication and non-medication allergies, and female gender are associated with a higher likelihood of having a FND. Studies with larger sample sizes and more controlled study designs are needed to better parse these interactions.
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