Neurological Dysfunction in Long COVID Should Not Be Labelled as Functional Neurological Disorder

Abstract

There have been suggestions that Long COVID might be purely functional (meaning psychological) in origin. Labelling patients with neurological dysfunction in Long COVID as having functional neurological disorder (FND) in the absence of proper testing may be symptomatic of that line of thought. This practice is problematic for Long COVID patients, as motor and balance symptoms have been reported to occur in Long COVID frequently. FND is characterized by the presentation of symptoms that seem neurological but lack compatibility of the symptom with a neurological substrate. Although diagnostic classification according to the ICD-11 and DSM-5-TR is dependent predominantly on the exclusion of any other medical condition that could account for the symptoms, current neurological practice of FND classification allows for such comorbidity. As a consequence, Long COVID patients with motor and balance symptoms mislabeled as FND have no longer access to Long COVID care, whereas treatment for FND is seldom provided and is ineffective. Research into underlying mechanisms and diagnostic methods should explore how to determine whether motor and balance symptoms currently diagnosed as FND should be considered one part of Long COVID symptoms, in other words, one component of symptomatology, and in which cases they correctly represent FND. Research into rehabilitation models, treatment and integrated care are needed, which should take into account biological underpinnings as well as possible psychological mechanisms and the patient perspective.

Co-ultraPEALut in Subjective Cognitive Impairment Following SARS-CoV-2 Infection: An Exploratory Retrospective Study

“…Whether neuro-long-COVID-19 should be considered a distinct pathological entity or not is controversial: some authors claim that its neurological signs and symptoms are poorly characterized and lack consistency, thus resembling functional disorders [ 5 ], while other authors openly oppose calling the neurological involvement in post-COVID-19 functional [ 6 ]. Be that as it may, direct SARS-CoV-2 invasion into the central nervous system, abnormal systemic and neurological immunological responses, cytokine storm, glial dysfunction, virosis-induced endothelial changes and other mechanisms have been proposed as pathogenetic mechanisms underlying post-COVID-19 neurological symptoms [ 7 ].…”