Clinical Presentations and Treatment Experiences of Functional Neurological Disorder in the Perinatal Period

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OBJECTIVE: The perinatal period (from conception to 12 months postpartum) is defined by major general medical and psychological transitions that may contribute to functional neurological disorder (FND). The authors examined symptoms and care pathways of FND during the perinatal period and relationships to maternal functioning, obstetric outcomes, and infant care. METHODS: Through convenience sampling, data from 41 individuals with FND during the perinatal period were identified in neurology and perinatal mental health service clinical records in the United Kingdom and Australia. Anonymized data on FND symptom course, treatment, delivery mode, and impacts on infant care were extracted from the records. RESULTS: The most prevalent diagnosis was functional seizures only (46%) or combined with motor FND (24%). Worsening of symptoms was most frequently reported in late pregnancy and postpartum (32% in the early postnatal period), but a substantial number of individuals were lost to follow-up. Comorbid depression (51%), anxiety disorder (54%), and posttraumatic stress disorder (39%) were prevalent. Cesarean delivery was common (42%), but neither cesarean nor epidural anesthesia was associated with exacerbation of preexisting FND symptoms. Nearly half of participants reported difficulties with infant care (49%); taking safety precautions was documented for individuals with both motor and seizure presentations. By 6-12 months postpartum, 38% reported a return to prepregnancy functioning, whereas 41% had persistent limitations. CONCLUSIONS: FND symptoms fluctuate during the perinatal period and can affect infant caregiving. Prospective observational studies could help inform care pathways for individuals of childbearing age with FND.

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