Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22491
Title: The outcome of acute functional neurological disorder: a meta-analysis of stroke-mimic presentations.
Authors: Simhan, Suhas;Thijs, Vincent N;Mancuso, Sam;Tsivgoulis, Georgios;Katsanos, Aristeidis;Alexandrov, Andrei V;Kanaan, Richard A A
Affiliation: Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian, University of Athens, Athens, Greece..
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
Department of Psychiatry, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian, University of Athens, Athens, Greece..
Issue Date: 22-Jan-2020
EDate: 2020-01-22
Citation: Journal of neurology 2020; online first: 22 January
Abstract: The prognosis of motor functional neurological disorder (FND) is considered poor; however, all data come from chronic cohorts collected by specialists. The aim of this study was to determine the clinical outcome of acute FND, captured as 'stroke-mimics'. A meta-analysis of studies with outcome data on functional stroke mimics. Authors were contacted to provide more information on their FND mimics, including baseline, discharge and follow-up stroke scales. A random effects meta-analysis of proportion of 'good outcome' was the primary measure of interest, with additional descriptive and statistical analysis. 'Good outcome' employed the usual conventions of modified Rankin Score (mRS) or National Institutes of Health Stroke Scale (NIHSS) ≤ 1. Eight studies with 79 patients were identified and analysed, all of cohorts undergoing thrombolysis. The mean age at presentation was 49.7 years with a 62% female preponderance, and median NIHSS score of 4. The proportion of patients with mRS or NIHSS ≤ 1 changed significantly from admission to discharge or follow up [from 24 (30%) to 50 (63%), p < 0.001]. Meta-analysis of the synthesized data showed the pooled standardized mean change (SMC) was statistically significant (SMC = - 1.28, [95% CI = -2.25, - 0.30], p = 0.010) indicating good symptomatic outcome for acute FND patients presenting as stroke-mimics. Heterogeneity was large. Patients presenting with acute motor FND have good outcome of their presenting symptoms by discharge and at follow-up, following thrombolysis for presumed stroke, in contrast to specialist cohorts. Demographic differences, in addition to the thrombolysis, are possible explanations for these more favourable results.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22491
DOI: 10.1007/s00415-020-09709-3
ORCID: 0000-0003-0992-1917
0000-0002-6614-8417
PubMed URL: 31970491
Type: Journal Article
Subjects: Conversion disorder
Functional neurological disorder
Stroke mimic
Appears in Collections:Journal articles

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