Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Division, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (Paredes-Echeverri, Maggio, Perez); Department of Physical Therapy, Massachusetts General Hospital, Boston (Maggio); Adult Psychiatry Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (Bègue); Laboratory for Clinical and Experimental Psychopathology, Department of Psychiatry, University of Geneva, Switzerland (Bègue); Institute of Psychiatry, Psychology and Neuroscience, King's College, London (Pick, Nicholson); and Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez).
J Neuropsychiatry Clin Neurosci. 2022 Winter;34(1):30-43. doi: 10.1176/appi.neuropsych.21010025. Epub 2021 Oct 29.
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.
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.
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.
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.
功能性神经障碍（FND）是一种核心神经精神疾病。迄今为止，在 FND 患者中观察到了有希望但不一致的神经回路特征，这表明我们在系统水平的神经生物学理解方面仍存在差距。因此，需要将其他重要的生理变量（包括自主神经、内分泌和炎症发现）纳入其中，以了解更完整的发病机制。
研究人员对 FND 的现有病例对照和队列研究进行了系统回顾和荟萃分析。从 1900 年 1 月 1 日至 2020 年 9 月 1 日，研究人员在 PubMed、PsycINFO 和 Embase 数据库中检索了 FND 患者自主神经、内分泌和炎症标志物的研究。在 2056 篇筛选记录中，有 66 篇被纳入综述，代表了 1699 名患者；20 篇文章的数据用于荟萃分析。
研究结果表明，与健康对照组（HCs）相比，患有 FND 的儿童和青少年的静息心率（HR）较高；在整个生命周期中，FND 患者的静息 HR 变异性也呈下降趋势。在成年人中，发作间期的 HR 可区分功能性癫痫发作和癫痫性癫痫发作的患者。其他 FND 患者的自主神经和内分泌特征存在异质性，有几项研究强调了个体差异的重要性。
FND 的炎症研究仍处于早期阶段。未来需要使用更大的样本量来考虑功能性神经症状与行为、心理、自主神经、内分泌、炎症、神经影像学和表观遗传学/遗传学数据之间的复杂相互作用。还需要更多的研究来确定 FND 在表型上是否在机制（和病因学）上相似或不同。
