Girls Don't Want to Have Fun-ctional Neurologic Disorder: A Case in Pregnancy and the Implications for Clinical Care
Document Type
Conference Proceeding
Publication Date
5-9-2025
Abstract
Functional neurologic disorder (FND) is a neurological condition that affects brain functioning, leading to physical impairments with no demonstrable changes in brain structure. The etiology is unknown. Patients commonly present with symptoms including seizure-like episodes, movement or cognition problems, slowness, fatigue, numbness, or inability to sense touch. These symptoms are not intentional and can improve with distraction. FND presents disproportionately in women of childbearing age, but little is known about FND in pregnancy. Reported cases demonstrate worsening of symptoms in pregnancy with complete resolution postpartum. FND is rare in pregnancy and postpartum. The diagnosis is challenging as it can be easily mistaken for other neurologic conditions leading to early delivery and interventions that can impose risks to the pregnancy.
A 26 yo G5P1212 presented at 26w2d with bilateral lower extremity weakness, clonus, and fasciculations. History included a prior preterm delivery at 23 weeks with neonatal demise, and a recent pregnancy complicated by preeclampsia with severe features (preEwSF). She had presented with similar neurologic symptoms, and extensive evaluation did not result in any neurologic diagnosis prenatally or postpartum. She was diagnosed with preEwSF and delivered at 29 weeks' gestation. Her symptoms completely resolved postpartum. During this admission, her preeclampsia evaluation was normal throughout admission and her BP was controlled on labetalol. She continued to have symptoms, requiring wheelchair assistance. Remaining evaluation included normal EKG, normal echocardiogram, normal repeat magnetic resonance imaging. AchR antibody for myasthenia gravis was negative. Asher presentation was not consistent with preeclampsia, further evaluation with electromyography was completed, indicating FND.
Evaluation in prior pregnancy when she presented with similar symptom included imaging with MRI, lab work, and neurology and ophthalmology evaluation. This workup yielded no neurological abnormalities. Physiatry recommended physical and occupational therapy (PT/OT) and baclofen to manage her tremors. Lower extremity tremors resolved with baclofen prior to discharge. She started to ambulate with assistance and was stable for discharge home. With continued outpatient PT and OT visits, she was able to wean her use of baclofen, and had complete resolution of her symptoms prior to admission at 35 weeks, when she presented in preterm labor and delivered via repeat cesarean section.
FND is a rare condition in pregnancy and postpartum. It is usually diagnosed by exclusion. It could lead to numerous interventions, including admission to the intensive care unit, medical and surgical treatments, and iatrogenic preterm delivery. Even when FND is diagnosed, management of symptoms can be elusive. Our goal was to highlight the importance of a multidisciplinary and comprehensive workup for patients presenting with neurologic symptoms during pregnancy to achieve an accurate diagnosis that leads to the best possible outcome.
Recommended Citation
Ismailova I, Marquez A, Hart E, Romero V. Girls don't want to have fun-ctional neurologic disorder: a case in pregnancy and the implications for clinical care. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025.
Abstract 1849