Pediatric Neurology

Biography

Biography: Jorina Elbers

Abstract

Objective: Pediatricians commonly see children reporting symptoms without a plausible medical explanation, even after extensive investigations. Such patients’ frequently present with multiple co-morbidities. We report the prevalence of children with multiple medically unexplained symptoms in a pediatric neurology clinic, describe their symptom profiles, and explore their association with adverse childhood experiences (ACEs).

Study Design: We retrospectively reviewed medical and social histories of 100 consecutive patients who had been treated at an outpatient pediatric neurology clinic. Patients were included if they were 5 years or older, and reported 4 or more medically unexplained symptoms (MUS) for longer than 3-months. Symptom profiles across six functional domains were recorded: 1) executive dysfunction, 2) sleep disturbances, 3) autonomic dysregulation, 4) somatization, 5) digestive symptoms, and 6) emotional dysregulation. ACEs were recorded and scored for all patients.

Results: Seventeen patients reported 4 or more MUS. Somatization, sleep disturbances and emotional dysregulation occurred in 100% patients, with executive dysfunction (94%), autonomic dysregulation (76%) and digestive problems (71%) in the majority. Forty-two children reported ACEs (42%); children with 4 or more MUS were more likely to report ACEs in comparison to other children (88% vs. 33%; p<0.0001). Of the 42 patients reporting ACEs, children with 4 or more MUS had a higher median ACE score (3 vs. 1; p<0.001).

Conclusions: Children with multiple medically unexplained symptoms should be screened for potential exposure to ACEs. A clinical profile of unexplained medical symptoms across multiple functional domains within the nervous system suggests putative neurobiological mechanisms involving nervous system dysregulation that require further study.