Functional Neurological Disorder in a Multidisciplinary Clinic: Demographic and Clinical Correlates
Roshni Singh1, Fei Tang2, Jason Margolesky3
1University of Miami Miller School of Medicine, 2Bruce W. Carter Department of Veterans Affairs Medical Center, 3University of Miami School of Medicine
Objective:
To characterize the multimorbid presentation of functional neurological disorder (FND) and examine associations between patient characteristics and outcomes.
Background:
FND arises from network dysfunction rather than structural brain abnormalities.1,2 Despite its prevalence, FND remains poorly understood and often stigmatized.1-4 Patients may experience non-epileptic seizures or movement symptoms causing substantial distress and disability.1,2,4 Few studies describe the multimorbid presentation of FND or associations between sociodemographic factors, clinical characteristics, and patient-reported attitudes and outcomes.
Design/Methods:
We established a multidisciplinary FND clinic integrating neurology, psychology, and physical therapy. Patients (n=49) completed questionnaires covering sociodemographic, medical and psychiatric history, and symptom domains. Questionnaire data and chart review were analyzed using descriptive statistics. Associations between clinical features and three continuous outcome measures, including diagnosis confidence, treatment confidence, and Clinical Global Impression-Severity (CGI-S) score, were evaluated with Pearson correlations, linear regression, and one-way ANOVA. Significance was set at p<0.05 (R v4.5.1).
Results:
Patients were predominantly women (69.4%), mean age of 55.4 years, white (79.6%), non-Hispanic (69.4%), married/partnered (57.4%), and college educated (63%). Mean symptom duration was 7.4 years, with averages of 3.8 primary concerns, 4.8 cognitive problems (range 0–10), and 13 physical problems (range 0–25). Common comorbidities included anxiety (76%), chronic pain (75%), depression (55%), headaches (53%), and poor sleep (41%). Nearly half (47%) reported abuse history. Functional dependence was prevalent, with 38% requiring assistance with instrumental activities of daily living (IADLs) and 25% requiring assistance with both activities of daily living (ADLs) and IADLs. CGI-S scores correlated with cognitive (r=0.32, p=0.03) and physical symptom burden (r=0.34, p=0.02), and ADL impairment (p<0.01). Diagnosis confidence correlated with physical symptom count (r=0.31, p=0.049). No associations were observed for marital status, abuse history, social support, depression, or anxiety.
Conclusions:
FND patients show high multimorbidity and functional impairment, underscoring the need for multidisciplinary, integrated care addressing neurological, psychological, and functional domains to improve outcomes.
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