2023 American Academy of Neurology Abstract Website

Objective:

To investigate if patients with functional neurological disorder (FND), with or without probable post-traumatic stress disorder (PTSD) and/or significant childhood maltreatment, differed in their reported FND symptom severity and physical health.

Background:

As a group, individuals with FND report an approximately 3-fold increase in adverse life experiences (ALEs) compared to healthy controls, and there is a positive correlation between symptom severity and the magnitude of ALEs. While not everyone with FND reports a history of ALEs, these data support the possibility of a trauma-subtype in this population

Design/Methods:

78 prospectively recruited patients with FND (functional seizures, n=34; functional movement disorder, n=56) completed self-report measures of symptom severity (Somatoform Dissociation Questionniare-20 (SDQ-20), Screening for Somatoform Disorders: Conversion Disorder subscale (SOMS:CD), Patient Health Questionniare-15 (PHQ-15)), physical health (Short Form Health Survey-36 (SF36-physical health)), traumatic experiences (Childhood Trauma Questionnaire (CTQ)), PTSD (PTSD Checklist-5 (PCL-5)), and other scales of predisposing vulnerabilities. We Bonferroni corrected all univariate analysis to adjust for multiple comparisons.

Results:

Patients with FND and probable PTSD (n=33) vs. those without probable PTSD (n=43) had statistically significant increased FND symptom severity scores and decreased physical health. In post hoc linear regressions, these findings remained significant adjusting for demographic variables, and: pathological dissociation; alexithymia; attachment styles; personality traits; resilience scores; functional seizures subtype; or moderate-to-severe childhood abuse and neglect scores; SOMS:CD and SDQ-20 findings also held adjusting for depression and trait anxiety scores. Separately, patients with FND and moderate-to-severe childhood abuse (n=46) vs. those without moderate-to-severe childhood abuse (n=32) showed statistically significant increased SDQ-20 and PHQ-15 scores; these finding also held in all secondary analyses.

Conclusions:

This study provides support for an FND trauma-subtype. Future research should investigate the neurobiological and prognostic relevance of a trauma-subtype in FND, including determining subtype cut-offs. Importantly, a trauma-subtype of neuropsychiatric disorders may cut across the spectrum of neurology and psychiatry.