Ducroizet Alexandra, Zimianti Ioanna, Golder Dawn, Hearne Kim, Edwards Mark, Nielsen Glenn, Coebergh Jan
Department of Neurology, Ashford St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK.
Barts Health NHS Trust, UK.
J Clin Neurosci. 2023 Apr;110:116-125. doi: 10.1016/j.jocn.2023.02.014. Epub 2023 Mar 3.
Functional Neurological Disorder (FND) is common and is often accompanied by multiple comorbid symptoms and conditions. There have been no large-scale studies exploring the change of its clinical manifestations and comorbidities. We used an online survey to assess FND patient characteristics, changes to fatigue, sleep and pain and comorbid symptoms and diagnoses, as well as treatment strategies. The survey was shared via the charities FND Action and FND Hope. 527 participants were included in the analysis. Most (97.3%) reported experiencing more than one core FND symptom. Many respondents reported associated pain (78.1%), fatigue (78.0%) and sleep disturbances (46.7%) before FND diagnosis which often increased thereafter. Rates of obesity were higher (36.9%) than in the general population. Obesity was associated with increased pain, fatigue and sleep difficulties. There was frequent weight gain after diagnosis. 50.0% of participants reported having other diagnoses prior to FND, while in 43.3% new comorbidities arise after FND diagnosis. Many respondents reported being dissatisfied with their care, expressing a wish for further follow-up from mental health (32.7%) and/or neurological services (44.3%). This large online survey further supports the phenotypic complexity of FND. High rates of pain, fatigue and sleep disturbance exist before diagnosis but monitoring for change is worthwhile. Our study identified major gaps in service provision; we highlight the importance of an open mind regarding change in symptoms; this could aid the early identification and management of co-morbidities, including obesity and migraine, which possibly have a negative impact on FND.
功能性神经障碍（FND）很常见，常伴有多种共病症状和情况。目前尚无大规模研究探讨其临床表现和共病情况的变化。我们通过在线调查评估FND患者的特征、疲劳、睡眠和疼痛的变化、共病症状和诊断以及治疗策略。该调查通过慈善机构FND行动和FND希望进行分享。527名参与者纳入分析。大多数（97.3%）报告经历过不止一种核心FND症状。许多受访者报告在FND诊断前存在相关疼痛（78.1%）、疲劳（78.0%）和睡眠障碍（46.7%），且此后往往会加重。肥胖率（36.9%）高于一般人群。肥胖与疼痛加剧、疲劳和睡眠困难有关。诊断后体重经常增加。50.0%的参与者报告在FND之前有其他诊断，而43.3%在FND诊断后出现新的共病。许多受访者报告对他们的治疗不满意，希望心理健康服务（32.7%）和/或神经科服务（44.3%）能进一步跟进。这项大型在线调查进一步支持了FND的表型复杂性。诊断前疼痛、疲劳和睡眠障碍发生率较高，但监测变化是值得的。我们的研究发现了服务提供方面的主要差距；我们强调对症状变化持开放态度的重要性；这有助于早期识别和管理共病，包括肥胖和偏头痛，它们可能对FND产生负面影响。
