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Functional Neurological Disorder Following COVID-19: Results From a Large International Electronic Health Record
Rok Berlot1,2,3, Livia Asan1,4, Timothy R Nicholson5
1Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Background:
Following COVID-19, an increased risk of neurological and psychiatric sequelae has been reported. Viral illnesses commonly trigger functional neurological disorder (FND). However, mechanisms beyond immediate biological effects may contribute to FND after COVID-19. While FND cases have been observed after COVID-19, the overall risk and contributing factors remain unclear. In this retrospective cohort study, we compared the rates of FND post-COVID-19 to other respiratory tract infections (RTIs), assessed the influence of disease severity, and the characteristics of newly diagnosed patients.
Methods:
We used TriNetX, a global electronic health record network. In total, 2,740,094 COVID-19 cases and 1846 post-COVID-19 FND cases were analysed. We compared FND incidence between 2 weeks and 6 months after COVID-19 to other RTIs and across cohorts of varying COVID-19 severity. Characteristics of individuals with new diagnoses of FND and migraine following COVID-19 were compared.
Results:
The incidence of FND was higher in COVID-19 patients with records of hospitalisation (OR 2.165; 95% CI 1.691-2.773) and emergency department visits (OR 1.412; 95% CI 1.069-1.864). Incidence was higher following COVID-19 compared to other RTIs, both in the first 2 years of the pandemic (0.033 vs. 0.021%, OR 1.555, 95% CI 1.271-1.902) and subsequently (0.038 vs. 0.027%, OR 1.394, 95% CI 1.173-1.657). Medical, neurological, and psychiatric comorbidities were more common in newly diagnosed post-COVID-19 FND compared to migraine.
Conclusions:
New-onset FND appears more likely after COVID-19 than other RTIs. Both the severity of the triggering illness and pre-existing individual vulnerability may contribute to the development of FND.
