Diagnosis and Management of Functional Neurological Disorders in Pediatric Patients: A Retrospective Single-Center Study

Introduction: Functional neurological disorders (FND) present diagnostic challenges in pediatrics, with an actual incidence likely higher than reported. This study aims to analyze FND cases in our center to optimize patient management and treatment. Methods: We conducted a retrospective, single-center observational study of pediatric patients diagnosed with FND from January 2020 to January 2024. Data were collected from electronic medical records, focusing on patient demographics, symptoms, diagnostic tests, treatments, and outcomes. Statistical analysis included descriptive and inferential statistics to determine associations with recovery. Results: We reviewed 37 patients, with a median age of 11 years and a predominance of females. Motor symptoms were most common (40.5%), followed by sensory disturbances and altered consciousness (29.7%). About 50% of patients presented more than one conversion symptom initially, increasing to 70% over all episodes. Complete symptom recovery was observed in 62% of patients, with recovery associated with motor and visual disorders. No significant associations were found between recovery and sex, psychiatric history, number of tests, or number of concomitant symptoms. Multiple complementary tests were performed in 78.3% of patients. Stress factors were identified in 59.4% of cases, mainly related to school problems. Discussion: FND in children is complex, often involving multiple symptoms. Recovery was positively associated with motor and visual disorders. The high frequency of complementary tests suggests an exclusion-based diagnostic approach. Stress factors, particularly school-related issues, are common. These findings highlight the need for increased follow-up and multidisciplinary interventions to improve outcomes. Further research is necessary to enhance diagnostic and treatment strategies for pediatric FND.