Titolo della tesi: Functional Neurological Disorders (FND) in Childhood and Adolescence: clinical pathways, prognostic factors, and the role of time
Functional Neurological Disorder (FND) represents a complex clinical category at the interface
between neurology and psychiatry. It is increasingly understood as a disorder of brain functioning
rather than structural pathology, arising from abnormal predictive coding and altered integration
of emotional, cognitive, and motor control systems. Despite growing recognition in adults,
evidence on developmental FND remains limited.
This doctoral thesis investigated FND in childhood and adolescence through three complementary
empirical studies addressing diagnostic, comparative, and prognostic aspects, with the
overarching aim of outlining a multidimensional and developmentally informed framework.
The first study focused on Functional/Dissociative Seizures (FDS) and evaluated the diagnostic
utility, safety, and feasibility of a structured Standardized Suggestive Seizure Induction Technique
(SSIT) protocol integrated into video-EEG monitoring. In a cohort of 25 pediatric patients, SSITs
reproduced habitual functional seizures in over 50% of cases, without adverse events, supporting
their value as transparent and ethically acceptable diagnostic procedures in child and adolescent
settings.
The second study provided a comparative analysis between FDS and Functional Motor Disorders
(FMD) in 43 young patients. Despite different outward phenomenology, both groups shared
overlapping neuropsychological and psychopathological features, including mild inefficiencies in
working memory, elevated anxiety, and dissociative tendencies, consistent with transdiagnostic
mechanisms of impaired emotion-action integration.
The third study examined prognostic determinants and healthcare pathways in pediatric FMD,
highlighting the critical role of early recognition and coordinated multidisciplinary treatment.
Shorter diagnostic latency and integrative rehabilitation were associated with improved recovery,
emphasizing the importance of timing as a determinant of clinical outcome.
Taken together, these findings contribute to a unified developmental model of FND, bridging
neurobiological, psychological, and systemic perspectives. The thesis underscores the need for
early, interdisciplinary, and person-centered approaches, promoting functional restoration
through timely intervention and collaborative care.
Keywords: Functional Neurological Disorders; Functional/Dissociative Seizures; Functional
Motor Disorders; Childhood; Prognosis; Diagnostic Timing; Predictive Coding.