Objective: To assess the outcomes of an early intervention in patients with functional neurological disorders (FND) that presented acutely in our emergency department.

Background: FND are common and may present acutely [1]. They are potentially disabling, but early diagnosis and treatment may improve outcome [2].

Method: Retrospective analysis of patients with FND admitted in the emergency department of our tertiary hospital, with the intervention of a neurologist in the acute phase. A positive diagnosis of the FND was effectively communicated to the patient following current recommendations [2, 3]. Online material was also provided (www.neurosymptoms.org) for further information about diagnosis, and an early ambulatory appointment with the same specialist was programmed.

Results: Ten cases were included in the analysis (eight female, mean age 33,8 years; range 21-58), from October 2018 to December 2019 [table 1]. In five cases symptoms consisted in functional hemiparesis with or without sensory disturbances, three cases of gait problems, one case of convergence spasm and one case of dystonia in the right limbs. Symptoms were functionally relevant for daily activities in all cases. Interestingly, five patients (50%) had history of migraine, although functional symptoms were not related to the headache. A positive diagnosis of FND was made on clinical grounds, although complementary tests were also performed, with normal results in all cases (head CT scan and blood tests in all cases; CT angiography, cranial MRI in 3). Two patients were admitted into the hospital to complete an observation period. The mean time from onset to first consultation in the hospital was 2,56 weeks (0-10). All patients were reassessed ambulatory 1-4 weeks after the first hospital visit, and followed for a mean time of 13,1 weeks (2-54). Neurological symptoms disappeared in 90% of cases during the follow-up, and one patient showed a partial improvement.

Conclusion: In our experience, the early diagnosis and intervention in FND with acute presentation was effective, with an early and sustained improvement of potentially disabling symptoms. Continuity of care with the same specialist and expertise in FND are likely to play a role in the positive outcomes.

References: 1. Cock HR, Edwards MJ. Functional neurological disorders: acute presentations and management. Clinical Medicine, 2018. 2. Stone J. Functional neurological disorders: the neurological assessment as treatment. Pract Neurol, 2016. 3. Stone J, Hoeritzauer I. How Do I Explain the diagnosis of Functional Movement Disorder to a Patient? Mov Disord Clin Pract. 2019

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