Background Functional neurological disorder (FND) is a common and potentially disabling neuropsychiatric condition. While its presentation can be extremely diverse, from aphonia to seizure activity, one of the most common symptoms is weakness of one or more limbs. Despite functional weakness being one of the most common presentations seen in neurological practice, little is known about its prevalence in an Emergency Department (ED) setting. Hereby, we aim to describe the demographic and clinical characteristics of patients attending the ED with limb weakness of an unknown and potentially functional aetiology.
Methods We carried out a retrospective electronic records review of all ED attendances with limb weakness as the presenting complaint, at Kings College Hospital. Patients admitted to the hospital were followed up until the point of discharge. The following clinical and demographic data were analyzed: age, gender, mode of arrival, psychiatric history and clinical diagnosis on discharge. Results: During the 15-month study period, 1340 patients presented with leg weakness at the ED, nearly half of these (47.54%) arrived by ambulance. 4.55% had unexplained weakness with no definite diagnosis on discharge. A significant proportion (62.31%) were admitted for further investigations; 6.35% of these were diagnosed with FND, while a further 25 patients (2.99%) were discharged with suspected FND. Patients with an FND diagnosis had a median age of 45 years; 62.96% were females, and they were significantly younger than male patients with FND (P=0.003). Less than half (44%) of the FND patients had one or more psychiatric diagnoses.
Discussion A diagnosis of functional leg weakness was given to 3.95% (53/1340) of patients presenting with leg weakness in the ED. It is striking that none of these patients were given a diagnosis of FND in the ED, but only after admission to a ward. 6.4% (86/1340) were discharged from the hospital with an unclear diagnosis, 14% of which a functional overlay was suspected. Main limitations of the study: it is retrospective and single-centre.
Conclusion This study highlights difficulties and obstacles in recognising and diagnosing functional presentations of limb weakness in the ED. There is a clear need for optimisation of the classification and coding system of the Emergency Department. Increased awareness and education around FND has the potential to raise diagnostic confidence and significantly improve patient experience and care.
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