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Abstract Details

Towards a Trauma Subtype of Functional Neurological Disorder: Impact on Symptom Severity and Physical Health
Aging, Dementia, Cognitive, and Behavioral Neurology
P5 - Poster Session 5 (11:45 AM-12:45 PM)
2-007
As a group, individuals with FND report an approximately 3-fold increase in adverse life experiences (ALEs) compared to healthy controls, and there is a positive correlation between symptom severity and the magnitude of ALEs. While not everyone with FND reports a history of ALEs, these data support the possibility of a trauma-subtype in this population

To investigate if patients with functional neurological disorder (FND), with or without probable post-traumatic stress disorder (PTSD) and/or significant childhood maltreatment, differed in their reported FND symptom severity and physical health.

78 prospectively recruited patients with FND (functional seizures, n=34; functional movement disorder, n=56) completed self-report measures of symptom severity (Somatoform Dissociation Questionniare-20 (SDQ-20), Screening for Somatoform Disorders: Conversion Disorder subscale (SOMS:CD), Patient Health Questionniare-15 (PHQ-15)), physical health (Short Form Health Survey-36 (SF36-physical health)), traumatic experiences (Childhood Trauma Questionnaire (CTQ)), PTSD (PTSD Checklist-5 (PCL-5)), and other scales of predisposing vulnerabilities. We Bonferroni corrected all univariate analysis to adjust for multiple comparisons.

Patients with FND and probable PTSD (n=33) vs. those without probable PTSD (n=43) had statistically significant increased FND symptom severity scores and decreased physical health. In post hoc linear regressions, these findings remained significant adjusting for demographic variables, and: pathological dissociation; alexithymia; attachment styles; personality traits; resilience scores; functional seizures subtype; or moderate-to-severe childhood abuse and neglect scores; SOMS:CD and SDQ-20 findings also held adjusting for depression and trait anxiety scores. Separately, patients with FND and moderate-to-severe childhood abuse (n=46) vs. those without moderate-to-severe childhood abuse (n=32) showed statistically significant increased SDQ-20 and PHQ-15 scores; these finding also held in all secondary analyses.

This study provides support for an FND trauma-subtype. Future research should investigate the neurobiological and prognostic relevance of a trauma-subtype in FND, including determining subtype cut-offs. Importantly, a trauma-subtype of neuropsychiatric disorders may cut across the spectrum of neurology and psychiatry. 

Authors/Disclosures
David L. Perez, MD, FAAN (Massachusetts General Hospital)
PRESENTER
Dr. Perez has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley: Brain and Behavior. The institution of Dr. Perez has received research support from NIH. The institution of Dr. Perez has received research support from Sidney R. Baer Jr. Foundation. Dr. Perez has received publishing royalties from a publication relating to health care.
Andrew John Guthrie Mr. Guthrie has nothing to disclose.
Sara Paredes-Echeverri, MD Dr. Paredes-Echeverri has nothing to disclose.