Functional neurological disorders in primary brain tumor patients

Objective: We sought to identify the phenomenon of functional neurological disorders in our primary brain tumor patient population. Moreover, we describe factors associated with a functional neurological disorder in this cohort of patients. Background: Functional neurological disorders can occur in the context of a known neurological diagnosis, commonly seen in epilepsy and movement disorder clinics. The pathophysiology of functional neurological disorders is thought to have underpinnings in both neurobiological and psychological roots. Primary brain tumors may lead to direct neurobiological deficits from the underlying tumor and its treatments, as well as the associated psychosocial stressors that come with the diagnosis. Design/Methods: Data collected as part of our PRoGREss patient registry (Pro00027120) between 11/21/2011 and 9/1/2021 were queried, and patients with documented functional neurological disorders were identified. Patient demographics, underlying brain tumor pathology, tumor location, presentation of functional neurological disorder, and outcomes were evaluated. Results: We identified ten patients with a known primary brain tumor diagnosis and the development of a functional neurological disorder. At the time of tumor diagnosis, the age range was 18 years to 55 years, with most patients being female (n=8), having a low grade glioma diagnosis (n=7), and no known prior psychiatric diagnoses (n=7). Nine patients were admitted to the hospital or evaluated in an emergency room for the functional neurological disorder. The most common functional neurological disorder was psychogenic nonepileptic seizures (all were confirmed with prolonged EEG monitoring). Common management strategies included close follow-up visits with outpatient neuro-oncology providers, referral to appropriate neurological subspecialty practices, and specialty care from psychiatry and psychology services. Conclusions: Functional neurological disorders can manifest in primary brain tumor patients and can lead to hospital admissions and emergency room visits. Management of these disorders involves a multidisciplinary, interprofessional approach.

Duke Scholars

Author Margaret Johnson Neurosurgery

Contributor Margaret Johnson Neurosurgery