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Functional neurological disorders after COVID-19 and SARS-CoV-2 vaccines: a national multicentre observational study
  1. Araceli Alonso-Canovas1,2,
  2. Monica M Kurtis3,
  3. Victor Gomez-Mayordomo4,
  4. Daniel Macías-García5,6,
  5. Álvaro Gutiérrez Viedma7,
  6. Elisabet Mondragón Rezola8,
  7. Javier Pagonabarraga9,10,
  8. Lidia Aranzabal Orgaz11,
  9. Jaime Masjuan1,2,
  10. Juan Carlos Martinez-Castrillo1,2,
  11. Isabel Pareés2,3
  1. 1 Medicine Department, Universidad de Alcalá, Madrid, Spain
  2. 2 Movement Disorders Unit, Neurology Department. IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
  3. 3 Functional Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
  4. 4 Department of Neurology, Institute of Neurosciences, Vithas Hospital Group, Madrid, Spain
  5. 5 CIBERNED, Madrid, Spain
  6. 6 Movement Disorders Unit, Neurology and Neurophysiology Department, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
  7. 7 Functional Disorders Unit, Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
  8. 8 Department of Neurology, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastian, Spain
  9. 9 Neurology Department, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Movement Disorders Unit, Barcelona, Spain
  10. 10 Sant Pau Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain
  11. 11 Internal Medicine Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
  1. Correspondence to Dr Araceli Alonso-Canovas, Movement Disorders Unit, Neurology Department, IRYCIS, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain; aracelialonsocanovas{at}gmail.com

https://doi.org/10.1136/jnnp-2022-330885

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    Introduction

    Functional neurological disorders (FNDs) are a common cause of neurology consultations.1 Dissociative seizures, motor and cognitive disorders are the main phenotypes. Diagnosis is made on positive terms: signs of inconsistency, incongruence and variability of physical signs with attention on clinical examination.1 Abnormal emotional processing and expectations are involved in the genesis and perpetuation of FND.1

    From the onset of SARS-CoV-2 pandemic, world population has been affected by high levels of stress, uncertainty and misleading information, with a potential impact on mental health. Different studies have ascertained an increase of FND consultations (threefold in an emergency department).2 On the development of SARS-CoV-2 vaccines, several cases of FND following vaccination were published, as well as an official warning from the Functional Neurological Society.3 Post-COVID-19 symptoms (known as Long-COVID-19) have also become a frequent reason for neurology consultation.4 Somatic symptom disorder may be common in these patients, and socioeconomic implications are vast.5

    Our experience is that a proportion of patients with FND describe an association with COVID-19 infection/vaccination. Here, we report a cohort of patients with FND for whom COVID-19 or SARS-CoV-2 vaccines were the main precipitant factors.

    Methods

    We performed an observational retrospective analysis in eight tertiary university hospitals with special interest in FND. Electronic clinical records (March 2020–November 2022) were reviewed and FND which developed after COVID-19 disease (Co-FND) or SARS-CoV2 vaccines (Va-FND) were recorded. Diagnosis of FND was performed by an expert, based on clinical history and positive motor or sensory signs on examination. Hence, …

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    Footnotes

    • Twitter @vicmayordomo

    • Contributors AA-C and IP: conception and design of the study, data recollection and analysis, manuscript writing and review MMK, VG-M, DM-G, AGV, EMR, JP and LAO: data recollection, manuscript review JM, JCM-C: conception and design of the study, manuscript review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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