Jungilligens Johannes, Marcinkowski Emma, Wehner Tim, Skodda Sabine, Popkirov Stoyan
Department of Neurology, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, Bochum, Germany.
Ruhr Epileptology, Department of Neurology, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, Bochum, Germany.
Eur J Neurol. 2025 Sep;32(9):e70338. doi: 10.1111/ene.70338.
The high prevalence of functional neurological disorders (FND) in specialized neurological services such as epilepsy centers or dizziness clinics is well established. Few studies exist that investigate the frequency of FND among neurology in-patients.
In-hospital patients with functional neurological symptoms as part of the presenting complaint were identified by combining prospective and retrospective case ascertainment over a period of 2 years. Demographic and clinical features as well as reimbursements were analyzed.
Across a total of 4648 in-hospital patients, 267 (5.7%) had functional neurological symptoms as a presenting complaint, and 217 (4.7%) were given a standalone FND diagnosis. All age groups and subtypes of FND were represented. FND comprised 2.4% of all cases admitted to the stroke unit for suspected stroke; 11.8% of all cases undergoing specialized epileptological workup; and 7.6% of cases admitted through the emergency department with a seizure disorder. Diagnostic coding of FND was inconsistent and associated with significantly lower per-day revenue when performed accurately.
FND is the third most common diagnosis among in-hospital neurological patients, which stands in stark contrast to its underrepresentation in clinical training, service provision, and research funding. Stroke-like presentations and seizures are common forms of FND among emergency admissions. Reimbursement mechanisms of the diagnosis-related groups system might disincentivize accurate diagnostic coding and contribute to a cycle of neglect within health care.
功能性神经障碍（FND）在癫痫中心或眩晕诊所等专业神经科服务中高发，这一点已得到充分证实。但很少有研究调查神经内科住院患者中FND的发生率。
通过前瞻性和回顾性病例确诊相结合的方式，对2年内住院的以功能性神经症状为主要诉求的患者进行识别。分析患者的人口统计学和临床特征以及费用报销情况。
在总共4648名住院患者中，267名（5.7%）以功能性神经症状为主要诉求，217名（4.7%）被单独诊断为FND。FND涵盖了所有年龄组和亚型。FND占因疑似中风入住卒中单元所有病例的2.4%；占所有接受专业癫痫检查病例的11.8%；占因癫痫发作障碍通过急诊科入院病例的7.6%。FND的诊断编码不一致，准确编码时每日收入显著较低。
FND是住院神经科患者中第三常见的诊断，这与其在临床培训、服务提供和研究资金方面的代表性不足形成鲜明对比。类似中风的表现和癫痫发作是急诊入院中FND的常见形式。诊断相关组系统的费用报销机制可能不利于准确的诊断编码，并导致医疗保健领域的忽视循环。
