202. Functional Neurologic Disorders: Recognition and Management

How can primary care providers better educate themselves about functional neurologic disorders to reduce stigma and support quicker treatment for their patients?

Ever wondered why some neurologic symptoms defy typical diagnostic tests? This week's episode of Pediatric Meltdown will talk about this mystery with guests Dr. Sarah Dixon and Dr. Alex Gamber, two experts in pediatric neurology. Through their expert insights, you'll learn about the difference between epileptic seizures and FND spells, and the importance of therapeutic approaches like cognitive behavioral therapy. With actionable advice for primary care providers and families alike, this episode is a treasure trove of knowledge. Learn about innovative treatment strategies and why understanding both the psychological and neurobiological aspects is so essential. Curious to know the ultimate strategies for tackling FND symptoms? tap on PLAY to discover the key clinical pearls now!

[04:31 -14:11] Defining Pediatric Functional Neurologic Disorders (FND)

• FND is a group of conditions causing nervous system symptoms without structural abnormalities.
• They result from malfunctions in how information is transmitted and received in the brain.
• The symptoms do not arise due to any other neurologic disorder.
• It represents an undamaged brain experiencing processing issues.

[14:12 - 25:52] Diagnostic Approaches for Functional Neurologic Disorders in Pediatrics

• Subconscious learned motor patterns play a significant role in FND.
• Resting state functional connectivity MRI studies show increased connectivity between emotional processing centers and motor control networks in FND patients.
• Functional movement disorders, including functional tremor and tics, exhibit distinct physical exam findings.
• Neurologists heavily rely on physical exam findings to diagnose functional disorders.

[25:53 - 34:46] Understanding Psychogenic Non-Epileptic Spells in FND Management

• Addressing the need for effective treatment interventions.
• Ensuring that patient and family concerns are acknowledged and managed.
• Importance of patient education in understanding their condition.
• Strategies for managing subacute subconscious pressure or stress in patients.

[34:47 - 45:48] Effective Communication in Diagnosing Pediatric FND

• Emphasize the importance of clear and compassionate communication when suspecting Functional Neurologic Disorder (FND) in pediatric patients.
• Highlight how setting the stage correctly can significantly influence the patient's treatment, prognosis, and overall improvement.
• Include educational information in the referral note to neurology, detailing the basics of FND diagnosis and the treatment plan.
• Use the referral note to walk through clinical reasoning and explain the natural history of FND.

[45:49 - 54:16] Closing segment Takeaways

Links to resources mentioned on the show

Taking Control of Your Seizures: Workbook

Joel M. Reiter, Donna Andrews, Charlotte Reiter, W. Curt LaFrance, JR

https://www.amazon.com/Taking-Control-Your-Seizures-Treatments/dp/019933501X

Neurosymptoms.org

FNDhope.org

Epilepsy Foundation: