Autonomic, Endocrine, and Inflammation Profiles in Functional Neurological Disorder: A Systematic Review and Meta-Analysis

被引:26
作者
Paredes-Echeverri, Sara [1 ]
Maggio, Julie [1 ,2 ]
Begue, Indrit [3 ,4 ]
Pick, Susannah [5 ]
Nicholson, Timothy R. [5 ]
Perez, David L. [1 ,6 ]
机构
[1] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, Funct Neurol Disorder Res Program,Cognit Behav Ne, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Phys Therapy, Boston, MA 02114 USA
[3] Univ Hosp Geneva, Adult Psychiat Div, Dept Mental Hlth & Psychiat, Geneva, Switzerland
[4] Univ Geneva, Dept Psychiat, Lab Clin & Expt Psychopathol, Geneva, Switzerland
[5] Kings Coll London, Inst Psychiat Psychol & Neurosci, London, England
[6] Harvard Med Sch, Massachusetts Gen Hosp, Dept Psychiat, Div Neuropsychiat, Boston, MA 02115 USA
关键词
PSYCHOGENIC NONEPILEPTIC SEIZURES; HEART-RATE-VARIABILITY; MOVEMENT-DISORDERS; DIFFERENTIAL-DIAGNOSIS; CONVERSION DISORDER; STRESS; RESPONSES; EMOTION; ADOLESCENTS; CHILDREN;
D O I
10.1176/appi.neuropsych.21010025
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: Functional neurological disorder (FND) is a core neuropsychiatric condition. To date, promising yet inconsistently identified neural circuit profiles have been observed in patients with FND, suggesting that gaps remain in our systems-level neurobiological understanding. As such, other important physiological variables, including autonomic, endocrine, and inflammation findings, need to be contextualized for a more complete mechanistic picture. Methods: The investigators conducted a systematic review and meta-analysis of available case-control and cohort studies of FND. PubMed, PsycINFO, and Embase databases were searched for studies from January 1, 1900, to September 1, 2020, that investigated autonomic, endocrine, and inflammation markers in patients with FND. Sixty-six of 2,056 screened records were included in the review, representing 1,699 patients; data from 20 articles were used in the meta-analysis. Results: Findings revealed that children and adolescents with FND, compared with healthy control subjects (HCs), have increased resting heart rate (HR); there is also a tendency toward reduced resting HR variability in patients with FND across the lifespan compared with HCs. In adults, peri-ictal HR differentiated patients with functional seizures from those with epileptic seizures. Other autonomic and endocrine profiles for patients with FND were heterogeneous, with several studies highlighting the importance of individual differences. Conclusions: Inflammation research in FND remains in its early stages. Moving forward, there is a need for the use of larger sample sizes to consider the complex interplay between functional neurological symptoms and behavioral, psychological, autonomic, endocrine, inflammation, neuroimaging, and epigenetic/genetic data. More research is also needed to determine whether FND is mechanistically (and etiologically) similar or distinct across phenotypes.
引用
收藏
页码:30 / 43
页数:14
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