Functional Neurological Disorder Research Articles

Charcot’s interest in faith healing

ABSTRACT Jean-Martin Charcot believed that “miraculous” cures followed the rules of nature and that the resolution of physical stigmata after pilgrimages to shrines followed the laws of physiology. He acknowledged that some of the patients he had failed to improve at La Salpêtrière had subsequently been cured by the “faith cure” at Lourdes, but he believed their recovery had occurred through “autosuggestion.” Although this term is more commonly associated with his collaborator Pierre Janet, it is clearly expressed in Charcot’s final pronouncements. Charcot’s recognition of the neurological origin of hysteria is central to contemporary ideas about the cause of functional neurological disorders, and even some components of his once derided treatment approach—including mental training, graded exercise, and medical hypnotism—are in vogue.

Evaluating Speech-Language Pathologists' Knowledge of Functional Speech Disorders

Purpose: The purpose of this article is to offer an evaluation of speech-language pathologists' (SLPs') experiences with and knowledge of functional speech disorders. Functional speech disorders occur as a part of functional neurological disorders, a complex disorder that is often overlooked and misdiagnosed. Through an assessment of experience with and common myths about functional speech disorders among SLPs, the importance of providing education to SLPs about this patient population is discussed. Method: As a part of the presentation about functional speech disorders during the 2023 American Speech-Language-Hearing Association Health Care Summit, 122 participants were asked to anonymously respond to a series of questions that outlined their demographics, training in functional speech disorders, and experiences with this patient population. Descriptive data are presented. Results and Conclusions: Among attendees, 58% were exposed to functional speech disorders in graduate school while 75% had seen a patient with a functional speech disorder, most of whom had also diagnosed the patients' communication disorder. This study highlights the role of the SLP in identifying and managing functional speech disorders and the increased attention this patient population has received over time, as well as the work yet to be done. Functional speech disorders are a legitimate clinical entity, for which a diagnosis can be made based on positive clinical features (i.e., is not a diagnosis of exclusion). The call to action includes guidance for clinicians, educators, and academic training programs to support this patient population. See the Appendix for a plain language summary.

Using Network Analysis to Examine the Brain Regions Connectivity of Functional Neurological Disorder Patient and Healthy Participant

Introduction: Functional neurological disorder (FND) is one of the most common causes of neuropathy, However, its cause continues to be mysterious. Understanding the underlying mechanisms of that is crucial for treatment strategies. The study was conducted on brain images resting state fMRI taken from two volunteers (functional neurological disorder patient and healthy subject)who had the same characteristics. Methods: We fitted Gaussian Graphical Models to a single subject data using a network approach. Results: Based on the results of the networks, the number of significant edges was more in the left hemisphere in the patient, but in the healthy person, the number of these non-zero edges was more in the right hemisphere. Both the networks related to the healthy person and the patient had high density. Therefore, it indicated that the regions considered by these 2 people were strongly related to each other. The results showed the existence of more links and positive relationships between the regions, most of which showed a strong relationship. Among these connections, there were also negative connections. The networks of the healthy participant with almost symmetrical structures and the patient with Functional neurological disorder showed different characteristics, including asymmetry between the hemispheres. Conclusion: this study is the first to demonstrate that the brain regions of both functional neurological disorder patient and healthy participant can be conceptualized as networks. The findings of this study add to a growing body of literature that functional neurological disorder patient brain regions can be analyzed using network approaches.

Functional neurological disorder in pregnancy, labour and the postpartum period: systematic review.

Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demographics, subtype of FND, timing of symptom onset, comorbidities, medications, type of delivery, investigations, treatment, pregnancy outcomes and FND symptoms at follow-up. We included 36 studies (34 case reports and 2 case series) describing 43 patients. Six subtypes of FND were identified: functional (dissociative) seizures, motor weakness, movement disorder, dissociative amnesia, speech disorders and visual symptoms. New onset of perinatal FND was more common in the third trimester and onwards. Some women with functional seizures were exposed to unnecessary anti-seizure prescriptions and intensive care admissions. Prospective studies are urgently needed to explore how FND interacts with women's health in the perinatal period.

The Neuroconnective Endophenotype, A New Approach Toward Typing Functional Neurological Disorder: A Case-Control Study.

Functional neurological disorder (FND) is a core neuropsychiatric condition that includes both physical and mental symptoms. Recently, a validated clinical phenotype termed neuroconnective endophenotype (NEP), which includes several physical and psychological characteristics together with joint hypermobility (hypermobility spectrum disorders), was found at a significantly higher frequency among patients with anxiety. The purpose of the present study was to examine the presence of the NEP among patients with FND. The authors conducted a multicenter case-control study comprising 27 FND patients and 27 healthy control participants (matched by sex and age) ages 13 to 58 years. Eight questionnaires were administered. Proportional differences were examined with Student's t tests, one-way analyses of variance, and chi-square tests. Differences between FND patients and control participants were observed. FND patients had higher sensory sensitivity, increased prevalence of hypermobility features (including relevant physical signs and symptoms), greater frequency of polarized behaviors, a greater number of both psychiatric and physical comorbidities, and an increase in the characteristics and sensations typical of anxiety. Particularly striking was the presence of the hypermobility spectrum in more than 75% of FND patients compared with 15% among control participants. FND patients presented higher scores in all five dimensions included in the NEP. Thus, this phenotype, solidifying the original association between anxiety and the hypermobility spectrum, could help to identify an FND subtype when evaluating and managing FND patients, because it provides a new global view of patients' physical and mental symptoms.

The Effectiveness of Brief Multidisciplinary Outpatient Treatment for Functional Neurological Disorder: A Pilot Study

Background: Functional neurological disorder (FND) is a common, costly, and debilitating condition with a guarded prognosis. Limited evidence supports providers about which treatment approaches to undertake. Evidence-based care for FND is urgently needed to improve patient outcomes. The objective of this study was to evaluate functional and psychological outcomes associated with a novel outpatient multidisciplinary treatment program for adults with FND. Methods: Participants included 18 sequentially referred adults who attended the five-day FND treatment program, including those who completed ( N = 13) and who were available for follow-up at six months ( N = 9). Intervention included assessment and up to five consecutive days of treatment including two group-administered psychoeducation sessions. Primary measures included the Timed Up and Go (TUG), the EQ-5D-5L index score, and the visual analogue scale (VAS), and the Canadian Occupational Performance Measure (COPM). Secondary outcomes included Battery for Health Improvement-2 (BHI-2) Depression and Anxiety subscales. Results: Significant improvement observed on COPM performance and COPM satisfaction; EQ-5D-5L index (as well as VAS) and TUG (p = < 0.05) immediately following five-day treatment. Improvement was gained at six months for BHI-2 Depression and Anxiety, and maintained for COPM performance, COPM satisfaction, EQ-5D-5L index, EQ-5D-5L VAS, and TUG. Conclusions: The findings of this preliminary work suggest that multidisciplinary treatment for FND has a positive impact on psychological and physical outcomes with results sustained up to six months.

Psychiatric Etiologies and Approaches in Altered Mental Status Presentations: Insights from Consultation Liaison Psychiatry.

Consultation liaison psychiatrists are frequently asked to evaluate patients with altered mental status (AMS). Psychiatrists have unique perspectives and approaches to care for confused patients, particularly optimizing facilitation of care and maintaining vigilance for diagnostic overshadowing. Psychiatrists also offer expertise in primary psychiatric illnesses that can overlap with AMS, and the most common etiology of AMS is delirium. In this article, we provide a consultation liaison psychiatrist perspective on AMS and related psychiatric conditions in addition to delirium. Manic and psychotic episodes have primary and secondary etiologies, with some symptoms that can overlap with delirium. Catatonia, neuroleptic malignant syndrome, and serotonin syndrome are potentially fatal emergencies, and require prompt index of suspicion to optimize clinical outcomes. Trauma sequelae, functional neurologic disorders, and dissociative disorders can present as puzzling cases that require psychiatric facilitation of care. Additionally, AMS is sometimes due to substance intoxication and withdrawal in the hospital. A nonstigmatizing approach to evaluation and management of delirium and AMS can ensure optimal patient care experiences and outcomes.

Real-time biopsychosocial antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

Functional neurological symptom disorder (FNSD) is a neuropsychiatric diagnosis referring to symptoms resembling those of neurological disorders, occurring without causal neuropathology. FNSD has a complex biopsychosocial aetiology but its mechanisms are poorly understood. Remote monitoring technologies (RMT) could provide critical insights into functional neurological symptoms (FNS) in real-world contexts. We examined the feasibility and acceptability of a novel RMT protocol, to identify psychobiological correlates and antecedents of FNS in everyday life. Seventeen individuals with FNS (seizures/motor) and 17 healthy controls (HC) completed ecological momentary assessments (EMA) eight times daily for 1-week, reporting FNS severity, associated physical and psychological symptoms, and subjectively significant events. Sleep quality was reported daily. Physiological variables were measured using wearable Fitbit 5 devices. Multilevel modelling examined variables associated with FNS variability. Average EMA completion rates were good in both groups (≥80%). At week-level, the FNS group reported significantly greater subjective arousal, pain, fatigue, dissociation, negative affect, daily events, stressful events, and sleep duration, compared to HC. Objective sleep disturbance and duration, and resting heartrate, were also significantly greater in the FNS sample. FNS severity correlated significantly with daily events, affect, subjective arousal, pain, fatigue and sleep disturbance, at day- or within-day levels. Daily events and negative affect were the most prominent time-lagged predictors of within-day moment-to-moment FNS severity. RMTs are feasible and acceptable tools for investigation of FNS in real-world settings, revealing daily events and negative affect as possible triggers of FNS. Interventions targeting affective reactivity and regulation might be beneficial in this group. Larger-scale, longer-term RMT studies are needed in this population.

Functional movement disorder similar to Parkinson’s disease: a case report

IntroductionFunctional neurological disorder challenges conventional medical understanding, presenting neurological symptoms without organic explanations. This report delves into the intricate interplay between psychological and physical manifestations, emphasizing the importance of timely diagnosis and intervention and its impact on a patient’s mental health and quality of life.Case presentationA 40-year-old single Iranian man was admitted for the third time owing to exacerbation of mood symptoms, including depression, irritability, aggression, suicidal ideation, and movement and sensory problems. The patient’s symptoms began with psychological stressors and family conflict, leading to muscle weakness and tremors in the left hand. Over a year, muscle weakness escalated, leading to slow movement, motor impairment in the lower limbs, and reliance on a cane for walking. The patient still exhibited symptoms, such as a mask-like face, stooped walking posture, and a relative improvement of symptoms periodically. At first, the patient was suspected of Parkinson’s disease and was placed on levodopa and amantadine. However, the medication was discontinued owing to an unsatisfactory response and the lack of strong evidence in favor of neurological problems on frequent examinations and reviews. Despite multiple hospitalizations, the patient’s symptoms remained unresolved. Finally, after years of investigations, based on specialists’ recommendations, he was admitted to the psychosomatic ward for diagnostic evaluationele, and he was diagnosed with functional neurological disorder (psychogenic parkinsonism). He underwent pharmacotherapy, electroconvulsive therapy, and psychotherapy. He was discharged with partial improvement of symptoms, but showed periods of relapse and remission during the following years.ConclusionThis case study illuminates functional neurological disorder complexities, emphasizing the need for a holistic diagnostic approach. Timely interventions, including psychological support, can alleviate symptoms, reduce healthcare costs, and improve the overall prognosis. The report contributes to evolving functional neurological disorder understanding in psychiatry and neurology. The report underscores early recognition, advocating for comprehensive interventions involving psychiatric support, cognitive-behavioral therapy, and patient psychoeducation.

Review of the fifth international conference on Functional Neurological Disorder (FND) in Verona, Italy, June 7–11 2024

Review of the fifth international conference on Functional Neurological Disorder (FND) in Verona, Italy, June 7–11 2024

ILLNESS PERCEPTION AND TREATMENT EXPECTATION IN PATIENTS WITH FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER AT LAHORE, PAKISTAN

OBJECTIVE To explore the perceived illness and treatment expectations of patients with Functional Neurological Symptom Disorder. DESIGN OF STUDY It is a Descriptive Research Design PLACE AND DURATION The study was executed at Department of Psychiatry of government and private teaching hospitals of Lahore, Pakistan over a period of 12 months, from Jan 2023 to Dec 2023. METHOD A total of 100 adult participants were recruited as per criteria. Demographic Information Questionnaire and Short Explanatory Model Interview (SEMI) were employed and the qualitative data generated from SEMI was converted to numerical codes and discrete categories by the method of stepwise reduction. The descriptive frequencies were then presented in the tabular format. RESULTS Majority of the participants were female, educated, students and housewives, with 1 – 6 months duration of the illness, mixed symptoms presentation, pseudo seizures and motor symptoms. The main reasons of onset of illness was mentioned as marriage related factors and familial and social factors and majority participants believe that magic can affect others. The intensity of the symptoms were perceived as ‘extreme intense’ associated with the fear about the worsening of symptoms and serious discomfort. The main difficulties due to illness was reported to be lack of interest in daily activities, and increase in problem in relationships. The patients expect proper treatment and prescription of medicines which was followed by responses that they will learn the diagnosis and will receive advice from doctors regarding their illness. CONCLUSION The patient’s perception towards their illness was serious and concerned and their expectations was receiving proper treatment, medications and learning the disorder and doctor’s advice.

Investigating current clinical practice in assessment and diagnosis of voice disorders: A cross-sectional multidisciplinary global web survey.

Published best-practice guidelines and standardized protocols for voice assessment recommend multidisciplinary evaluation utilizing a comprehensive range of clinical measures. Previous studies report variations in assessment practices when compared with these guidelines. To provide an up-to-date evaluation of current global multidisciplinary practice patterns and the opinions of otolaryngologist, ear, nose and throat (ENT) and speech-language pathology (SLP) clinicians on initial assessment and differential diagnosis of adults with voice disorders (VDs). ENTs and SLPs worldwide who had worked with VDs within the last 10 years completed an anonymous online survey. Themes explored demographic information about the clinical practice, information about diagnostic assessment pathways, clinical assessments routinely used for initial voice evaluation and clinician perceived value of clinical assessments important for diagnosis. Patterns in the clinical practice of 88 SLPs and 21 ENTs from 18 countries with 1 to more than 25 years' experience were analysed. Clinicians provided services across a range of locations, and a range of assessment pathways was available for initial evaluation. Case history, laryngoscopy and auditory-perceptual measures were the most frequently selected assessments. Most clinicians favoured formal assessment measures for auditory-perceptual evaluation. Clinicians placed equal weighting on ENT and SLP assessment to aid diagnosis for muscle tension VDs and functional neurological voice disorders (FVDs). Practice patterns for initial diagnostic voice assessment are largely consistent with the currently published guidelines. Decisions for the selection of assessment tools vary according to VD classification, and assessment decisions appear to be guided by case history. Clinicians are not always following established protocols for obtaining reliable standardized measures. Further research is needed to understand the barriers to adhering to standardized protocols and to develop evidence for the use of case history in the process of VD diagnosis. What is already known on the subject Best-practice guidelines recommend a multidisciplinary and multidimensional assessment of adults with vocal symptoms. Prior uni-disciplinary survey studies have reported a divergence in clinical practice with the recommended guidelines. No previous studies have examined otolaryngologists and SLPs concurrently to investigate the multidisciplinary approach clinicians' use in a diagnostic voice assessment. What this paper adds to the existing knowledge This study highlights new insights into multidisciplinary voice evaluation practice patterns with an emphasis on diagnostic assessment from a global perspective. The findings build on prior research exploring clinical assessment pathways, service utilization and clinicians' preferences when selecting clinical tools to inform a differential diagnosis. What are the potential or actual clinical implications of this work? This paper provides insights to inform future service and resource planning to ensure the delivery of evidenced-based diagnostic assessment pathways. This study also makes recommendations for areas of future research to understand barriers to clinicians following recommended best-practice guidelines.

Functional neurological disorder and gut microbiome: Casual or causal relationship?

Functional neurological disorder (FND), or conversion disorder, is a psychosomatic condition that affects the voluntary motor and/or sensory functions of the patient. Its origin is not yet fully understood, but the main risk factors related to this disorder include exposure to recent psychological stressors and previous experience of aversive episodes during childhood, such as abuse, family dysfunction, and neglect. The symptoms of FND result from complex interactions involving the central nervous system and also the endocrine and immune systems. In this work, we hypothesized the relationship between the gut microbiome and the pathophysiology of FND because both share several common features, such as the effects of neurotransmitters, the hippocampal expression of brain-derived neurotrophic factor, and the inflammatory responses. Based on these common aspects, we suggested that stress, gut microbiome, and inflammation factors induce chronic and systemic inflammation of the brain causing neurological disorders, including FND. More specific studies are warranted to validate the casual or causal relationship between FND and the gut microbiome.

An exploration of UK speech and language therapists' treatment and management of functional communication disorders: A mixed-methods online survey.

Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs. To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken. An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks. There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues. Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence-based interventions to provide adequate care. What is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge This is the first UK-wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence-based interventions. What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence-based practice.

Practical strategies for caring for patients with functional neurological disorder in the ED

AbstractFunctional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow‐up care. Consistent and respectful language is important when managing patients with FND. Creating a calm environment reduced stress and symptom exacerbation. Thorough history taking and examination can help build the patient's confidence in their diagnosis. Validating symptoms and providing a clear explanation of the diagnosis are important. FND presentations, such as functional weakness and seizures, require tailored interventions with early involvement of physiotherapy and/or psychological support. A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient‐centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.

An introduction to functional neurological disorders in the emergency department

An introduction to functional neurological disorders in the emergency department

B - 12 Differences in Quality of Life in Students with Functional Neurological Disorders by School Setting

Abstract Objective Attending school in person for students with Functional Neurological Disorder (FND) has been recommended for improved functioning and reduced symptoms. There is little to no research measuring the impact of school setting on quality of life. This study investigates whether school setting impacts parent-perceived quality of life (QoL) in children with FND. Method The study included 142 patients (ages 7–19 years old) diagnosed with FND that were seen in an outpatient clinic at Children’s Medical Center, Dallas. Patients were classified as either participating in homeschool, regular in-person schooling, or in-person schooling with an Individualized Education Plan (IEP) or Section 504 accommodations. This did not include children being homeschooled solely due to COVID-19 school closures. A parent or guardian completed the PedsQL questionnaire. A single factor ANVOA was utilized to identify significant differences between groups. Post hoc comparisons using the Tukey HSD test were then conducted. Results Results revealed overall significant differences between groups (p0.1). Conclusions Results of this study support the recommendation of attending school in person, with or without formal support. Participation in typical daily routines may improve overall impact of pediatric FND.

Biomarkers and Rehabilitation for Functional Neurological Disorder.

Functional neurological disorder, or FND, is widely misunderstood, particularly when considering recent research indicating that the illness has numerous biological markers in addition to its psychiatric disorder associations. Nonetheless, the long-held view that FND is a mental illness without a biological basis, or even a contrived (malingered) illness, remains pervasive both in current medical care and general society. This is because FND involves intermittent disability that rapidly and involuntarily alternates with improved neurological control. This has in turn caused shaming, perceived low self-efficacy, and social isolation for the patients. Until now, biomarker reviews for FND tended not to examine the features that are shared with canonical neurological disorders. This review, in contrast, examines current research on FND biomarkers, and in particular their overlap with canonical neurological disorders, along with the encouraging outcomes for numerous physical rehabilitation trials for FND. These findings support the perspective endorsed here that FND is unquestionably a neurological disorder that is also associated with many biological markers that lie outside of the central nervous system. These results suggest that FND entails multiple biological abnormalities that are widely distributed in the body. General healthcare providers would benefit their care for their patients through their improved understanding of the illness and recourses for support and treatment that are provided in this review.

Incidence and pattern of neurological emergencies in Ramadan

ABSTRACT Background The impact of Ramadan fasting on various neurological emergencies remains relatively unexplored. This study aimed to clarify the incidence and pattern of the different neurological emergencies in Ramadan compared to Shaaban. Methods In this cross-sectional study, all adult patients attending the emergency room at two Egyptian centers with neurological emergencies during Shaaban and Ramadan were evaluated. Clinical, laboratory, and radiological assessments were made on an individual basis upon which the diagnosis of neurological disorder was made. IBM SPSS Version 25 was used to analyze the data. Results Seventy-twenty patients were included, 382 during Shaaban and 338 during Ramadan. Among causes of delirium, the frequency of dehydration was significantly higher, and the frequency of illicit drug abuse was significantly lower during Ramadan compared to Shaaban (P = 0.004, 0.030, respectively). The incidence of ICH was significantly reduced during Ramadan compared to Shaaban (10.8% vs 19.7%, P = 0.031). The incidence of cardioembolic strokes significantly increased during Ramadan than Shaaban (40.5% vs 26.4%, P = 0.014), whereas the incidence of small vessel disease (SVD) significantly decreased during Ramadan than Shaaban (21.6% vs. 42.1%, P < 0.001). The incidence of a single seizure was significantly higher in Ramadan than in Shaaban (69.4% vs. 34.6%, P = 0.007). The incidence of functional neurological disorders was significantly reduced in Ramadan than in Shaaban (P < 0.001). Conclusion The incidence of delirium caused by illicit drug abuse, ICH, SVD, and functional neurological disorders declined during Ramadan, while the incidence of delirium triggered by dehydration, cardioembolic strokes, and a single seizure increased during Ramadan.

Clinical characteristics and management of functional neurological disorders (FND) mimicking stroke in emergency settings: a functional stroke mimic cases.

FNDs mimicking a stroke represent a growing challenge in the emergency department (ED). A comprehensive diagnostic approach involving clinical evaluation and neuroimaging is essential to differentiate stroke from mimics. The safety profile of thrombolysis justifies its use where FNDs cannot be ruled out. This approach highlights the need for more precise diagnostic tools and protocols to improve patient care and reduce unnecessary treatments. Distinguishing FNDs from actual cerebrovascular events is critical yet difficult, particularly under time constraints. Given the urgency and potential severity of strokes, intravenous thrombolysis is frequently administered even when FNDs cannot be definitively excluded. This retrospective study analyzed data of participants admitted to the Trieste University Hospital Stroke Unit between January 2018 and December 2022, focusing on those presenting with sudden-onset focal neurological deficits mimicking a stroke, with some presenting within the reperfusion treatment window (<4.5 h from symptoms onset). We obtained detailed clinical evaluations and neuroimaging, and administered thrombolytic therapy in selected cases. We included 84 participants presenting with stroke mimics (average age of 45 yo) predominantly female (65.5%). Most common presentations: hemiparesis or hemisensory loss (75%), speech disorder (10.7%), vertigo/gait disorders (4.8%). History of psychiatric disorders was found in 32.1% of cases, and 48.8% had prior neurological disease or stroke risk factors. Advanced neuroimaging was performed in 43 cases yielding normal or non-specific results. Thrombolysis was safely administered in 31%. Patients mostly recovered within the first 24 h from admission (44.7%). We compared this FND's sample with 291 patients with mild ischemic stroke (NIHSS ≤7).