Diagnosis of neurological conversion disorder is difficult. Considerable
overlap in symptomatology occurs with progressive neurological
degenerative disease, pervasive refusal syndrome, depressive illness,
chronic fatigue syndrome, and other conditions. Conversion symptoms
can also coincide with organic neurological disease. Successful
management requires a sensitive, confident, multidisciplinary approach.
Multiple or repeated investigations can be counterproductive in resolving
symptoms. This report describes three children, one male and two female,
aged between 9 and 10 years, who were referred for evaluation of
progressive neurological symptoms. Each progressed to a completely
dependent state within 8 weeks of referral, requiring nasogastric feeding
and total assisted care. A convincing psychosocial trigger was not
identified in any case. Improvement occurred only when investigations
were ceased and rehabilitation commenced. Long-term follow-up has
revealed an excellent outcome for all three children.