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The outcome of acute functional neurological disorder: a meta-analysis of stroke-mimic presentations

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Abstract

Objective

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’.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

We are grateful to the corresponding authors of the included studies for providing us with access to their data.

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Authors

Corresponding author

Correspondence to Richard A. Kanaan.

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Conflicts of interest

V. T. has received travel support and honoraria for participation in advisory boards and speaker fees from Boehringer Ingelheim, the manufacturer of alteplase. The other authors report no disclosures.

Ethical standard

Participants gave written, informed consent as per their contributing studies.

Appendix 1 Authorship Roles

Appendix 1 Authorship Roles

SS designed and drafted the manuscript; VT design ed and revised the manuscript; SM performed the statistical analysis and revised the manuscript; GT, AK and AA played major roles in the acquisit ion of data and revised the manuscript; RK conceived and designed the study and revised the manuscript.

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Simhan, S., Thijs, V., Mancuso, S. et al. The outcome of acute functional neurological disorder: a meta-analysis of stroke-mimic presentations. J Neurol 267, 1353–1357 (2020). https://doi.org/10.1007/s00415-020-09709-3

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  • DOI: https://doi.org/10.1007/s00415-020-09709-3

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