Prognosis of functional neurologic disorders
Prognosis of functional neurologic disorders
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DOI：
10.1016/b978-0-12-801772-2.00043-6
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发表时间：
2016-01-01
期刊：
影响因子：
--
通讯作者：
Stone, J.
中科院分区：
文献类型：
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作者：
Gelauff, J.;Stone, J.
功能性(心理)神经疾病的预后很重要，因为它能够帮助回答患者和照顾者的问题，确定治疗是否值得，并找出哪些因素预测结果。我们回顾了两篇关于功能性运动障碍和分离性(非癫痫)发作的系统综述，以及关于功能性视觉和感觉症状的其他研究。方法论问题包括研究样本和结果的异质性、诊断怀疑和转诊偏差、可用研究的小规模和回溯性设计、随访期间可能的治疗方法以及文献综述偏差。在大多数研究中，功能性运动症状和心理性非癫痫发作在大多数患者的随访中保持不变或更严重。生活质量和工作状况的衡量标准在后续行动中往往很差。在随访中误诊的频率与其他神经和精神障碍一样低。症状持续时间长是最明显的阴性预测因素。早期诊断和年轻似乎预示着良好的结局。情绪障碍和人格障碍是不一致的预测因素。在一些研究中，诉讼和国家福利被发现是负面预测因素，但其他研究发现，它们不会影响结果。
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients' and carers' questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. We reviewed data on prognosis of functional neurologic disorders from two systematic reviews on functional motor disorders and dissociative (nonepileptic) seizures as well as additional studies on functional visual and sensory symptoms.Methodologic problems include heterogeneity in studied samples and outcome measures, diagnostic suspicion and referral bias, small size and retrospective design of available studies, possible treatments during follow-up, and literature review bias.With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. Measures of quality of life and working status were often poor at follow-up. Frequency of misdiagnosis at follow-up was as low as other neurologic and psychiatric disorders.Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. Emotional disorders and personality disorders were inconsistent predictors. Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.