Recent advances in understanding the neurobiology of pediatric functional neurological disorder

ABSTRACT

Introduction

Functional neurological disorder (FND) is a neuropsychiatric disorder that manifests in a broad array of functional motor, sensory, or cognitive symptoms, which arise from complex interactions between brain, mind, body, and context. Children with FND make up 10%–20% of presentations to neurology services in children’s hospitals and up to 20% of adolescents admitted to hospital for the management of intractable seizures.

Areas Covered

The current review focuses on the neurobiology of pediatric FND. The authors present an overview of the small but growing body of research pertaining to the biological, emotion-processing, cognitive, mental health, physical health, and social system levels.

Expert opinion

Emerging research suggests that pediatric FND is underpinned by aberrant changes within and between neuron-glial (brain) networks, with a variety of factors – on multiple system levels – contributing to brain network changes. In pediatric practice, adverse childhood experiences (ACEs) are commonly reported, and activation or dysregulation of stress-system components is a frequent finding. Our growing understanding of the neurobiology of pediatric FND has yielded important flow-on effects for assessing and diagnosing FND, for developing targeted treatment interventions, and for improving the treatment outcomes of children and adolescents with FND.

KEYWORDS:

• Functional neurological disorder (FND)
• Functional seizures (FS)
• biopsychosocial
• Adverse childhood experiences (ACEs)
• neuron-glial networks
• stress-system activation

Article highlights

• Pediatric FND is common: children with FND make up 10%–20% of presentations to neurology services in children’s hospitals.

• FND is underpinned by aberrant changes within and between neuron-glial (brain) networks.

• A variety of factors, on multiple system levels – physiological, emotional, cognitive, relational, and relating to adverse childhood experiences – contribute to brain network changes.

• Activation or dysregulation of the stress system is a frequent finding in children with FND

• Recent advances in understanding of neurobiology have led to the development of FND-specific treatment interventions.

• Prompt diagnosis and treatment – presumably before neural network changes become entrenched – result in good outcomes.

Acknowledgment

The authors would like to acknowledge all the children, adolescents, and families – from different parts of the world – that took part in the studies reported in this review. Without the donation of their time and good will, the current knowledge base in the field of pediatric FND would still be sparce.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.