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TOPLINE:

Functional neurologic disorder (FND) commonly occurs with other comorbid neurologic disorders and psychiatric illness and is associated with higher mortality, emergency presentations, and healthcare use than multiple sclerosis (MS), new research showed, highlighting systemic gaps in dedicated care.

METHODOLOGY:

• Researchers retrospectively analyzed a cohort of 148,727 patients (mean age, 39 years; 70% women) with an initial diagnosis of FND between 1995 and 2024 using electronic health records across 17 countries from TriNetX.
• Data on demographics and lifetime comorbidities were extracted.
• Clinical outcomes were compared between propensity score-matched cohorts diagnosed between 2015 and 2024, including all FND vs MS, FND-motor vs MS, and FND-seizure vs epilepsy.
• The analysis was controlled for age, sex, race, and ethnicity.

TAKEAWAY:

• FND rates were 52% for FND-motor, 48% for FND-seizure, 34% for FND-sensory, and 8% for FND-mixed presentations.
• Neurologic comorbidities were recorded in 78.5% of patients with FND, including epilepsy (33%), sleep disorders (33%), migraine (27%), and polyneuropathies (10%), whereas psychiatric comorbidities included mood disorders (52%) and anxiety disorders (51%).
• Compared with patients with MS, those with FND had higher rates of mortality (5% vs 4%; odds ratio [OR], 1.27), emergency presentations (45% vs 30%; OR, 1.90), inpatient stays (53% vs 33%; OR, 2.26), long-term drug therapy (37% vs 33%; OR, 1.23), problems related to employment (2% vs 0.5%; OR, 3.26), and caregiver dependency (7% vs 5%; OR, 1.41) (P < .001 for all).
• Compared with patients with MS, those with FND-motor had similar rates of wheelchair dependency (3% in both) and emergency intubation as those with MS (2% in both).

IN PRACTICE:

“These findings confirm and extend the recognition of FND as a complex multisystem disorder with frequent comorbidities,” the investigators wrote.

“The clinical and healthcare impact of FND makes it a central priority for neurology, warranting increased healthcare and research funding,” they added.

SOURCE:

The study was led by Livia Asan, MD, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. It was published online on May 11 as a research letter in JAMA Neurology.

LIMITATIONS:

The study was limited by its retrospective design, diagnostic misclassifications, incomplete coding, and reliance on electronic health records.

DISCLOSURES:

One investigator was funded by Deutsche Forschungsgemeinschaft. Disclosure information for the study investigators is available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.