Teodoro Tiago, Chen Jiaying, Gelauff Jeannette, Edwards Mark J
Neurosciences Research Centre, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK.
Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Eur J Neurol. 2023 May;30(5):1505-1514. doi: 10.1111/ene.15721. Epub 2023 Feb 22.
Acute health events, including infections, can trigger the onset of functional neurological disorder (FND). It was hypothesized that a proportion of people with long COVID might be experiencing functional symptoms.
A systematic review of studies containing original data on long COVID was performed. The frequency and characteristics of neurological symptoms were reviewed, looking for positive evidence suggesting an underlying functional disorder and the hypothesized causes of long COVID.
In all, 102 studies were included in our narrative synthesis. The most consistently reported neurological symptoms were cognitive difficulties, headaches, pain, dizziness, fatigue, sleep-related symptoms and ageusia/anosmia. Overall, no evidence was found that any authors had systematically looked for positive features of FND. An exception was three studies describing temporal inconsistency. In general, the neurological symptoms were insufficiently characterized to support or refute a diagnosis of FND. Moreover, only 13 studies specifically focused on long COVID after mild infection, where the impact of confounders from the general effects of severe illness would be mitigated. Only one study hypothesized that some people with long COVID might have a functional disorder, and another eight studies a chronic-fatigue-syndrome-like response.
Neurological symptoms are prevalent in long COVID, but poorly characterized. The similarities between some manifestations of long COVID and functional disorders triggered by acute illnesses are striking. Unfortunately, the current literature is plagued by confounders, including the mixing of patients with initial mild infection with those with severe acute medical complications. The hypothesis that long COVID might in part correspond to a functional disorder remains untested.
急性健康事件，包括感染，可引发功能性神经障碍（FND）的发作。据推测，一部分长期新冠患者可能正在经历功能性症状。
对包含长期新冠原始数据的研究进行了系统综述。对神经症状的频率和特征进行了回顾，寻找表明潜在功能性障碍的阳性证据以及长期新冠的假定病因。
在我们的叙述性综述中，总共纳入了102项研究。最常报告的神经症状是认知困难、头痛、疼痛、头晕、疲劳、睡眠相关症状以及味觉减退/嗅觉丧失。总体而言，未发现有任何作者系统地寻找FND的阳性特征。一个例外是三项描述时间不一致性的研究。一般来说，神经症状的特征不足以支持或反驳FND的诊断。此外，只有13项研究专门关注轻度感染后的长期新冠，在这种情况下，严重疾病的一般影响所带来的混杂因素的影响会得到减轻。只有一项研究推测一些长期新冠患者可能患有功能性障碍，另外八项研究推测存在类似慢性疲劳综合征的反应。
神经症状在长期新冠中很常见，但特征描述不佳。长期新冠的某些表现与急性疾病引发的功能性障碍之间的相似之处很明显。不幸的是，当前文献受到混杂因素的困扰，包括初始轻度感染患者与严重急性医疗并发症患者的混合。长期新冠可能部分对应于功能性障碍这一假设仍未得到验证。
