Functional neurological disorders among hospitalized patients in a resource-limited setting: current situation in Colombia and paths to improvement

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Abstract
Background: Functional neurological disorders (FND) are increasingly recognized in various clinical settings. However, early diagnosis and appropriate treatment remain challenging among hospitalized patients. Objective: To describe the clinical characteristics, diagnostic process, treatment, and outcomes of hospitalized patients with FND and to propose a pathway for improvement. Methods: We conducted a retrospective chart review of hospitalized adult patients diagnosed with FND between 2020 and 2023 at a tertiary hospital in Colombia. Follow-up was conducted via phone interviews. Results: Sixty-seven patients were included, 84% female, with a median age of 34 (24–47) years. The most common FND subtypes were weakness (57%) and seizures (49%), with 37% presenting mixed FND. Concomitant symptoms and comorbid medical, neurological, and psychiatric conditions were frequent. Misdiagnosis was common, mostly as stroke or epilepsy/status epilepticus. Only 12% were correctly identified at admission, highlighting a lack of early recognition. The diagnostic process reflected an exclusion-based approach and underuse of appropriate diagnostic criteria for FND. Most patients underwent imaging and additional testing, 16% required extensive workups, and 13% were exposed to potentially harmful interventions. Treatment for FND primarily included outpatient psychotherapy (61%), psychiatric follow-up (66%), and antidepressants (37%). Standard outpatient physiotherapy was only indicated in 21%, and neurology follow-up was not considered in one-third of cases. Among patients contacted by phone ( n = 51), 37% reported partial or insufficient understanding of the diagnosis. Conclusions: Limited awareness of FND diagnosis and management is a major factor in misdiagnosis and iatrogenic harm. We proposed an inpatient pathway to improve care for these patients.
Funding Information
  • National University of Colombia

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