The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms

Issue title: Neuropsychiatric Aspects of Neurorehabilitation

Guest editors: Matthew E. Peters, Lindsey J. Gurin, Davin K. Quinn and Durga Roy

Article type: Research Article

Authors: Jobin, Kaiden^a | Wang, Meng^b | du Plessis, Sané^a | Silverberg, Noah D.^c | Debert, Chantel T.^{a; *}

Affiliations: [a] Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada | [b] Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada | [c] Department of Psychology, University of British Columbia, Vancouver, BC, Canada

Correspondence: [*] Address for correspondence: Chantel Debert, MD MSc FRCPC, Associate Professor, Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. E-mail: [email protected].

Abstract: BACKGROUND:Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion. OBJECTIVE:To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS. METHODS:Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates. RESULTS:We found that total RPQ score ( βˆ = 0.27; 95% CI = [0.16, 0.38]), GAD-7 score ( βˆ = 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score ( βˆ = 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]). CONCLUSION:The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.

Keywords: Post-concussion symptoms, functional neurological disorder, rehabilitation, concussion, anxiety, depression, avocational rehabilitation, concussion, Post-concussion syndrome (PCS), Traumatic brain injury (TBI)

DOI: 10.3233/NRE-237002

Journal: NeuroRehabilitation, vol. 53, no. 2, pp. 199-208, 2023