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The epidemiology of functional stroke mimic (FSM) patients: a systematic review and meta-analysis

Jones, AT; O'Connell, NK; David, AS; (2020) The epidemiology of functional stroke mimic (FSM) patients: a systematic review and meta-analysis. European Journal of Neurology , 27 (1) pp. 18-26. 10.1111/ene.14069. Green open access

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Abstract

Background Stroke mimics form a significant proportion of cases in acute stroke services and some present with functional neurological disorder. Little is known about the prevalence or clinical characteristics of functional stroke mimics (FSMs). Methods A systematic literature search and meta‐analysis was carried out on published studies reporting suspected stroke and stroke mimic rates; 114 papers met inclusion criteria of which 70 provided a FSM rate. Random‐effects models estimated prevalence rates across settings and moderators of FSM rate. Findings Pooled proportions indicate 25% of suspected stroke cases were stroke mimics (95% CI, 22%‐27%). Within the 67 studies providing positive FSM rates, FSMs represented 15% (95% CIs, 13%‐18%) of stroke mimics and 2% of suspected strokes (95% CIs, 2%‐3%). FSMs were younger and more likely to be female, presented more with weakness/numbness but less with reduced consciousness or language problems. Stratified analyses suggest higher stroke mimic rates in primary care vs acute settings (38% v 12%) but higher FSM rates in stroke units compared to primary care (24% v 12%). Functional rates were higher in studies that were descriptive, retrospective and in patients receiving thrombolysis. Discussion Several studies report the proportion of functional stroke patients presenting to stroke services. FSMs have discernible demographic and clinical characteristics, but there is a conspicuous lack of evidence on their presentation or guidance for treatment. The social and psychological mechanisms underlying FSM presentations need more accurate quantification to help inform stroke pathways and improve care for these patients.

Type: Article
Title: The epidemiology of functional stroke mimic (FSM) patients: a systematic review and meta-analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/ene.14069
Publisher version: https://doi.org/10.1111/ene.14069
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: functional disorder, meta-analysis, prevalence, stroke, systematic review
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10081639
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