Functional neurological disorder among neurology in-patients

Abstract

$\bf Background$ The high prevalence of functional neurological disorders (FND) in specialized neurological services such as epilepsy centers or dizziness clinics is well established. Few studies exist that investigate the frequency of FND among neurology in-patients. $\bf Methods$ In-hospital patients with functional neurological symptoms as part of the presenting complaint were identified by combining prospective and retrospective case ascertainment over a period of 2 years. Demographic and clinical features as well as reimbursements were analyzed. $\bf Results$ Across a total of 4648 in-hospital patients, 267 (5.7%) had functional neurological symptoms as a presenting complaint, and 217 (4.7%) were given a standalone FND diagnosis. All age groups and subtypes of FND were represented. FND comprised 2.4% of all cases admitted to the stroke unit for suspected stroke; 11.8% of all cases undergoing specialized epileptological workup; and 7.6% of cases admitted through the emergency department with a seizure disorder. Diagnostic coding of FND was inconsistent and associated with significantly lower per-day revenue when performed accurately. $\bf Conclusions$ FND is the third most common diagnosis among in-hospital neurological patients, which stands in stark contrast to its underrepresentation in clinical training, service provision, and research funding. Stroke-like presentations and seizures are common forms of FND among emergency admissions. Reimbursement mechanisms of the diagnosis-related groups system might disincentivize accurate diagnostic coding and contribute to a cycle of neglect within health care