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Functional neurological symptoms are an important comorbidity in multiple sclerosis. They should be explained to the patient as they impact the quality of life and the workability of patients with multiple sclerosis.

Functional neurological symptoms (FNS) are the most common cause of disabilities in neurological diseases and have been reported in 20% of patients with neurology-related disorders. An in-depth examination and history aid in determining FNS in patients with MS (pwMS). MS disease is burdensome on patients’ physical and mental health; the addition of FNS in these patients will further deteriorate their condition. This study published in the journal Frontiers in Neurology aimed to determine the prevalence of FNS in pwMS and to find the link between the two.

Evaluation Between Neurologists’ Ratings Before and After Discharge

The correlation between the frequency distribution of neurologists’ ratings both before discharge and after admission was evaluated and found to be significant, with a value of 0.78 and a p-value less than 0.001.

Frequency of Underlying Pathology Explaining Clinical Picture 

Previous studies determined that 1.3% of pwMS had a clinical picture that could not be explained by the underlying structural pathology caused by MS during their hospitalization. In 5.6% of cases, the clinical picture was partially explained, and in 10.3% of pwMS, the clinical picture was half explained by structural pathology. In 27.8% of cases, the overall clinical picture was primarily explained by structural pathology, and in 55.1% of MS patients, the clinical picture was entirely explained by the underlying structural pathology.

Neurologists Rate Symptom Presentation in Sample of Patients
A sample of 234 patients was taken, and neurologists rated their numerous symptoms. The total rating scale was out of 5, and only 5 symptoms were rated as 1, which means not all were explained by underlying structural pathology. There were no epileptic seizures reported in the data. The majority of all the symptoms were explained completely by underlying pathology.

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Correlation Between Clinical Picture Ratings by Healthcare Workers Before Discharge

The study examined the distribution of overall clinical picture ratings by neurologists, physiotherapists, and occupational therapists before the patients were discharged. The ratings given by neurologists and physiotherapists were more closely related (with a correlation of 0.67 and p-value less than 0.001), while occupational therapists’ ratings were negatively correlated with neurologists’ (with a correlation of -0.02 and p-value of 0.91) and poorly correlated with physiotherapists’ ratings (with a correlation of 0.31 and p-value of 0.13).

Correlation Between Functional Neurological Symptoms and Quality of Life 

Patients with higher FNS had fewer working hours per day (mean = 4.64 hours) than those with structural symptoms (mean = 6.12 hours). The quality of life was better in pwMS with structural pathologies, as indicated by higher scores in the data.

Association Between Disability Pensions and Overall Clinical Picture Rating

In the comparison of disability pensions, pwMS with no disability pension had the lowest overall clinical picture rating (mean = 4.32), which means they had the fewest symptoms explained by underlying structural pathology. In contrast, those with full disability pensions had the highest rating.


Piliavska, K., Dantlgraber, M., Dettmers, C., Jöbges, M., Liepert, J., & Schmidt, R. (2023). Functional neurological symptoms are a frequent and relevant comorbidity in patients with multiple sclerosis. Frontiers in Neurology, 14. https://doi.org/10.3389/fneur.2023.1077838