Medically unexplained neurological symptoms in children and
adolescents: A study within WHO's international classification of functioning,
disability and health framework
Affiliations: Department of Pediatric Neurology, Great Ormond Street
Hospital, London, UK | Department of Physiotherapy, Great Ormond Street
Hospital, London, UK | Department of Occupational Therapy, Great Ormond
Street Hospital, London, UK | Department of Psychological Medicine, Great Ormond
Street Hospital, London, UK | Department of Social Service, Great Ormond Street
Hospital, London, UK
Note: [] Correspondence: Dr. Prab Prabhakar, Department of Pediatric
Neurology, Great Ormond Street Hospital, London, WC1N3JH, UK. Tel.: +44 207 405
9200 ext 8308; Fax: +44 207 829 7923; E-mail: Prab.Prabhakar@gosh.nhs.uk
Abstract: We studied the prevalence, disability and outcome of medically
unexplained neurological symptoms (MUNS) in children/adolescents admitted to a
tertiary pediatric neurology centre, within the framework of WHO's
international classification of functioning disability and health. Of the 652
admissions over 2007?2009, 82 episodes of admissions (12.6%) in 52 (35 females;
median age 13; range 6?17 yr) documented to have MUNS original cohort (OC) were
studied; of which 25 (49%) were re-evaluated using questionnaires after a
minimum of 2 yr following their discharge follow-up cohort (FC). The
predominant manifestations in OC were loss of neurological function n = 27,
paroxysmal events n = 14, pain syndrome n = 4, others n = 7. The majority of
the FC (21/25; 84%) had ongoing neurological symptoms, of which it remained the
same pattern in four, became worse (two) and improved (five). Four expressed
new, additional symptoms. Among the OC, 29(56 %) had impaired mobility and 25
(48%) had poor school attendances. Among the FC, eight of the 14 (58%) with
impaired mobility showed good improvement, whereas none with good mobility
deteriorated. Similarly, 11/15 (73%) with poor school attendances showed
improvement with attendances to full time education or employment. In the OC,
utilization of resources was high. In the FC, no alternative neurological (or
psychiatric) diagnosis was, given in any. Over half of adolescents and families
expressed that their experience to multi-disciplinary team assessment was
helpful. Despite persistence of symptoms in the majority, our two-year outcome
data from the studied cohort shows improvement in daily activities and
participation in two-thirds.
Keywords: Medically unexplained neurological symptoms (MUNS), International classification of functioning disability and health
(ICF), multidisciplinary team (MDT)
