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Published Online: 9 May 2024

Functional Neurological Disorder Presenting After Concussion: A Retrospective Case Series

Ginger Polich, M.D., M.S. [email protected], Gaston Baslet, M.D., Mary Angela O’Neal, M.D., Rishab Gupta, M.D., and LCDR Geoffrey Raynor, M.D.Authors Info & Affiliations
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
Volume 36, Number 4
https://doi.org/10.1176/appi.neuropsych.20230154
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Abstract

Objective:

Although a majority of individuals recover from a concussion within weeks of the index injury, a substantial minority of patients report persistent postconcussion symptoms. Some of these symptoms may reflect a diagnosis of functional neurological disorder (FND). The authors evaluated the relationship between persistent postconcussion symptoms and FND symptoms.

Methods:

In this retrospective chart review, the authors characterized demographic and clinical information from 50 patients with a confirmed diagnosis of FND whose functional neurological symptoms started after a concussion.

Results:

Patients who developed FND after a concussion had high rates of baseline risk factors for both persistent postconcussion symptoms and FND. After the concussive event, functional neurological symptoms presented abruptly or developed insidiously over time. Functional neurological symptoms ranged widely and included gait symptoms, seizures, speech and language symptoms, weakness, sensory symptoms, tremors, and vision and oculomotor symptoms.

Conclusions:

Functional neurological symptoms can arise after a concussion. FND should be considered in the differential diagnosis of individuals presenting with neurological symptoms beginning after a concussion. By failing to recognize functional symptoms, clinicians may inadvertently reinforce negative health-related beliefs regarding a patient’s injured brain.

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Information & Authors

Information

Published In

Go to The Journal of Neuropsychiatry and Clinical Neurosciences
Go to The Journal of Neuropsychiatry and Clinical Neurosciences
The Journal of Neuropsychiatry and Clinical Neurosciences
Volume 36 • Number 4 • Fall 2024
Pages: 333 - 339
PubMed: 38720622

History

Received: 8 September 2023
Revision received: 15 December 2023
Accepted: 20 December 2023
Published online: 9 May 2024
Published in print: Fall 2024

Keywords

  1. Concussion
  2. Functional Neurological Disorder
  3. Functional Seizures
  4. Persistent Postconcussion Symptoms
  5. Rehabilitation (Neuropsychiatric)
  6. Traumatic Brain Injury

Authors

Details

Ginger Polich, M.D., M.S. [email protected]
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O’Neal), Brigham and Women’s Hospital, Boston; Department of Psychiatry, Brigham and Women’s Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor).
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Gaston Baslet, M.D.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O’Neal), Brigham and Women’s Hospital, Boston; Department of Psychiatry, Brigham and Women’s Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor).
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Mary Angela O’Neal, M.D.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O’Neal), Brigham and Women’s Hospital, Boston; Department of Psychiatry, Brigham and Women’s Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor).
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Rishab Gupta, M.D.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O’Neal), Brigham and Women’s Hospital, Boston; Department of Psychiatry, Brigham and Women’s Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor).
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LCDR Geoffrey Raynor, M.D.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O’Neal), Brigham and Women’s Hospital, Boston; Department of Psychiatry, Brigham and Women’s Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor).
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Notes

Send correspondence to Dr. Polich ([email protected]).

Competing Interests

Dr. Polich has received funding from the Foundation for Physical Medicine and Rehabilitation to study rhythmic auditory stimulation for functional gait disorders. Dr. Baslet has received royalties from Oxford University Press and payment for lectures on functional neurological disorders. Dr. O’Neal has received royalties from Oxford University Press, Springer, and UpToDate and has served as a consultant to Crico and Teladocs. Dr. Gupta reports no financial relationships with commercial interests.

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