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Current Neurology and Neuroscience Reports (2023) 23:637–643
https://doi.org/10.1007/s11910-023-01298-8
REVIEW
The Financial Burden ofFunctional Neurological Disorders
MeaganWatson1· JaredWoodward1· LauraA.Strom1
Accepted: 28 August 2023 / Published online: 11 September 2023
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023
Abstract
Purpose of Review Functional neurological disorder (FND) is a common and severely debilitating condition lacking clinical
ownership, existing between neurology and psychiatry. This article reports the findings of recent research investigating the
economic costs of FND diagnosis and management. We define what the costs are, why they exist, and suggest actionable
steps to reduce them.
Recent Findings The financial burden of FND exists across the globe characterized by high healthcare utilization result-
ing in exorbitant direct and indirect costs for the patient, healthcare system, and society. Inadequate medical education and
stigmatization of the disorder prolong the time to diagnosis, during which cyclical utilization of inpatient and emergency
department services drive up costs. Despite being cost-effective, lack of accessible treatment compounds the issue, leaving
patients without a reliable exit.
Summary Recent findings support an increased awareness and the need for a cultural shift to overcome the financial burden
associated with this underserved population.
Keywords Functional neurological disorder· FND· Conversion disorder· Finances· Healthcare economics· Healthcare
costs
Introduction
Functional Neurological Disorder (FND) is a common
condition that few know about and even fewer believe in
and truly understand. With an estimated prevalence of 50
per 100,000, FND is recognized as the second-most com-
mon reason for presentation to outpatient neurology clin-
ics, worldwide [1, 2]. The disorder represents a spectrum
of symptoms which outwardly appear like other neurologi-
cal diseases (e.g., epilepsy) but do not originate from the
same neuropathology. Instead, FND is a multi-network brain
disorder where neural circuitry between and within brain
regions is disrupted, thought to be associated with a com-
bination of factors including, childhood trauma, complex
psychopathology, and present environment, among others [3,
4]. We cannot predict who will develop FND, but we know
the onset is more common in Caucasian females, in their
20s and 30s, who are primarily of low socioeconomic status
[2, 5, 6••]. Historically, the disorder has been approached
by clinicians using an exclusion mindset, first ruling out
all other possible medical explanations for the symptom’s
etiology [7]. Only when brain imaging is clear, diagnostic
neurophysiology studies are normal, and blood tests return
negative, does FND become a real possibility. Some clini-
cians continue investigations with costly gene panels and
immunotherapy trials, manifesting in a medical odyssey
based around a single biological explanation [8]. These
seemingly excessive investigations are more common than
they should be as FND is a recognized diagnosis in the diag-
nostic statistical manual (DSM) and functional MRI studies,
albeit with small sample sizes, show significant differences
in the brains of persons with FND compared to controls [3].
Reported differences in neural circuitry explain deficiencies
in persons suffering with FND. Experts suggest we pres-
ently have enough supporting evidence to safely transition
from a “rule-out” to a”rule-in” diagnostic approach due to
the reliability of a clinical exam [9]. An additional critical
factor influencing this new ideology is the unprecedented
healthcare utilization that results from a “rule out” approach
[8]. This review aims to summarize the most recent literature
discussing the financial burden of FND delineating what the
* Meagan Watson
Meagan.watson@cuanschutz.edu
1 Department ofNeurology, University ofColorado, Aurora,
CO, USA
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