Functional Neurological Symptom Disorder (FNSD)

Functional Neurological Symptom Disorder (FNSD) is characterized by neurological, sensory, or motor symptoms without identifiable neurological pathology. In children and adolescents, FNSD presents additional complexities due to frequent comorbidities such as anxiety, depression, and functional pain, complicating diagnosis and treatment. This study explores the clinical presentations, diagnostic challenges, and the organo-psychiatric interplay in FNSD through three pediatric cases. Case 1 involved a 12-year-old boy with epileptiform seizures, behavioral disinhibition, and cognitive deterioration, eventually diagnosed with bilateral temporal focus and hippocampal atrophy. Case 2 describes a 16-year-old boy with treatment-resistant headaches, paraplegia, and post-traumatic stress disorder (PTSD), where no structural abnormalities were found. Case 3 details a 12-year-old girl with motor tics and tremors, later diagnosed with Wilson’s disease. The study highlights the need for a multidisciplinary approach to diagnose and manage FNSD, as physical and psychological stressors significantly contribute to its manifestations.