A Scoping Review of Functional Neurological Disorder in Sexual and Gender Minority People (P1-12.004)

Abstract

<h3>Objective:</h3> To report the literature regarding sexual and gender minority (SGM) people with functional neurological disorder (FND). <h3>Background:</h3> Minority stress and resilience theory describes the risks and protective factors that constitute social determinants of health and may increase neurological disparities among SGM communities. Little is known about the prevalence and experiences of SGM people with FND. <h3>Design/Methods:</h3> A search string with descriptors of SGM identity and functional somatoform disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles that included SGM people diagnosed with FND, conversion disorder, or hysteria published before May 24, 2022, yielding 2940 items entered into Covidence. Two neurologists screened titles and abstracts based on predefined criteria, followed by a full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent data abstraction and statistical description. <h3>Results:</h3> Our search identified 4 published cases of presumed cisgender sexual minority (SM) people and 1 gender minority (GM) person with an FND or related diagnosis. GM people were overrepresented (5/106 [5%]) in a FND clinic sample compared to the general population (&lt;1%). Among cases, predominant presenting symptoms included seizures (n=2), tic-like behaviors (n=1), swallowing dysfunction (n=1), or mixed presentation with disturbed consciousness (n=1). Initial diagnoses were made by electroencephalography (n=3) and clinical history and non-specific studies (n=2). No neurological exam data were reported. Stressors related to SGM experience preceded onset in 3 cases with improvement coinciding with discussion and/or affirmation of SGM identity in 3 cases. <h3>Conclusions:</h3> Despite a methodologically rigorous search, limited data exist on FND in SGM communities. The data support the relevance of minority stress and resilience theory within the broader context of a stress-diathesis framework. More research is needed to understand and address known barriers to SGM-affirming care, which may be further exacerbated by FND-related stigma. <b>Disclosure:</b> Dr. L’Erario has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ohio State University, University of Colorado, Sacred Heart University, The LOFT LGBT Community Center . Dr. L’Erario has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Weiss Law. Dr. L’Erario has received publishing royalties from a publication relating to health care. Dr. Fusunyan has nothing to disclose. Mr. Stave has nothing to disclose. Dr. Waugh has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Two independent law firms. The institution of Dr. Waugh has received research support from AAN. Dr. Wilkinson-Smith has nothing to disclose. Ms. Roldan has nothing to disclose. Dr. Keuroghlian has received publishing royalties from a publication relating to health care. Jack Turban has nothing to disclose. Dr. Perez has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley: Brain and Behavior. The institution of Dr. Perez has received research support from NIH. The institution of Dr. Perez has received research support from Sidney R. Baer Jr. Foundation. Dr. Perez has received publishing royalties from a publication relating to health care. Dr. Maschi has nothing to disclose. Dr. Rosendale has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. The institution of Dr. Rosendale has received research support from American Academy of Neurology. The institution of Dr. Rosendale has received research support from NIH StrokeNet Fellowship. Dr. Rosendale has received publishing royalties from a publication relating to health care.