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Objectives <p>To synthesise evidence on prognosis, functional outcomes, and prognostic factors across functional neurological disorder (FND) subtypes and age groups.</p> Design <p>Systematic review with structured narrative synthesis (PRISMA 2020).</p> Data sources <p>MEDLINE (PubMed), Embase, PsycINFO, CINAHL, CENTRAL, Web of Science, and Scopus from inception to [insert last search date], plus citation searching.</p> Eligibility criteria <p>Systematic reviews/meta-analyses, cohort studies with follow-up &gt;  = 3&#xa0;months, and treatment-outcome studies with follow-up &gt;  = 6&#xa0;months in patients diagnosed with FND or equivalent historical labels.</p> Data extraction and synthesis <p>Two reviewers independently screened and extracted data. Risk of bias was assessed using AMSTAR-2 (reviews), QUIPS (prognostic cohorts), RoB 2 (RCTs), and ROBINS-I (non-randomised interventions). Outcomes were harmonised into remission, improvement, or persistent/unchanged/worse; functional outcomes and quality of life were synthesised descriptively.</p> Results <p>Across adult FND subtypes, long-term outcomes were generally unfavourable for functional motor disorder and functional seizures, with complete remission uncommon and persistent symptoms at follow-up in most cohorts. Functional outcomes (employment, disability status) and quality of life were frequently poor and did not consistently correlate with symptom change. Sensory-only and functional visual symptoms were associated with relatively more favourable symptomatic outcomes, although evidence was limited and heterogeneous. Paediatric cohorts demonstrated substantially better symptom outcomes than adult populations, with most children showing improvement or remission, but psychosocial burden remained common. Longer symptom duration prior to diagnosis was the most consistent predictor of poor outcome across subtypes. Treatment-outcome studies suggested benefit from specialist interventions in selected patients, particularly when delivered early, but remission rates remained modest.</p> Conclusions <p>Adult FND is often associated with persistent symptoms and long-term functional impairment, with heterogeneity by subtype and age. Early diagnosis and timely access to specialist, function-focussed care appear important for improving outcomes.</p>

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Prognosis and outcomes in functional neurological disorder: a PRISMA-compliant systematic review with subtype-specific synthesis and clinical translation

  • 期刊论文

  • 发表日期：

    2026年3月15日

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  • Ioannis Mavroudis,
  • Foivos Petridis,
  • Katerina Franekova,
  • Sotirios Papagiannopoulos,
  • Dimitrios Kazis

摘要

Objectives

To synthesise evidence on prognosis, functional outcomes, and prognostic factors across functional neurological disorder (FND) subtypes and age groups.

Design

Systematic review with structured narrative synthesis (PRISMA 2020).

Data sources

MEDLINE (PubMed), Embase, PsycINFO, CINAHL, CENTRAL, Web of Science, and Scopus from inception to [insert last search date], plus citation searching.

Eligibility criteria

Systematic reviews/meta-analyses, cohort studies with follow-up >  = 3 months, and treatment-outcome studies with follow-up >  = 6 months in patients diagnosed with FND or equivalent historical labels.

Data extraction and synthesis

Two reviewers independently screened and extracted data. Risk of bias was assessed using AMSTAR-2 (reviews), QUIPS (prognostic cohorts), RoB 2 (RCTs), and ROBINS-I (non-randomised interventions). Outcomes were harmonised into remission, improvement, or persistent/unchanged/worse; functional outcomes and quality of life were synthesised descriptively.

Results

Across adult FND subtypes, long-term outcomes were generally unfavourable for functional motor disorder and functional seizures, with complete remission uncommon and persistent symptoms at follow-up in most cohorts. Functional outcomes (employment, disability status) and quality of life were frequently poor and did not consistently correlate with symptom change. Sensory-only and functional visual symptoms were associated with relatively more favourable symptomatic outcomes, although evidence was limited and heterogeneous. Paediatric cohorts demonstrated substantially better symptom outcomes than adult populations, with most children showing improvement or remission, but psychosocial burden remained common. Longer symptom duration prior to diagnosis was the most consistent predictor of poor outcome across subtypes. Treatment-outcome studies suggested benefit from specialist interventions in selected patients, particularly when delivered early, but remission rates remained modest.

Conclusions

Adult FND is often associated with persistent symptoms and long-term functional impairment, with heterogeneity by subtype and age. Early diagnosis and timely access to specialist, function-focussed care appear important for improving outcomes.