Medically unexplained neurological symptoms in children and adolescents: A study within WHO's international classification of functioning, disability and health framework

Abstract

We studied the prevalence, disability and outcome of medically unexplained neurological symptoms (MUNS) in children/adolescents admitted to a tertiary pediatric neurology centre, within the framework of WHO's international classification of functioning disability and health. Of the 652 admissions over 2007–2009, 82 episodes of admissions (12.6%) in 52 (35 females; median age 13; range 6–17 yr) documented to have MUNS original cohort (OC) were studied; of which 25 (49%) were re-evaluated using questionnaires after a minimum of 2 yr following their discharge follow-up cohort (FC). The predominant manifestations in OC were loss of neurological function n = 27, paroxysmal events n = 14, pain syndrome n = 4, others n = 7. The majority of the FC (21/25; 84%) had ongoing neurological symptoms, of which it remained the same pattern in four, became worse (two) and improved (five). Four expressed new, additional symptoms. Among the OC, 29(56 %) had impaired mobility and 25 (48%) had poor school attendances. Among the FC, eight of the 14 (58%) with impaired mobility showed good improvement, whereas none with good mobility deteriorated. Similarly, 11/15 (73%) with poor school attendances showed improvement with attendances to full time education or employment. In the OC, utilization of resources was high. In the FC, no alternative neurological (or psychiatric) diagnosis was, given in any. Over half of adolescents and families expressed that their experience to multi-disciplinary team assessment was helpful. Despite persistence of symptoms in the majority, our two-year outcome data from the studied cohort shows improvement in daily activities and participation in two-thirds.

Keywords

Medically unexplained neurological symptoms (MUNS) - International classification of functioning disability and health (ICF) - multidisciplinary team (MDT)