Department of Health Sciences, Hull York Medical School, (HYMS), University of York, York YO10 5DD, UK.
Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter EX2 5AX, UK.
Viruses. 2023 Mar 18;15(3):783. doi: 10.3390/v15030783.
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.
有人认为长新冠可能纯粹是由心理因素引起的（即功能性）。在没有进行适当检查的情况下，将长新冠中出现神经功能障碍的患者诊断为功能性神经疾病（FND），可能反映了这种思维方式。这种做法对长新冠患者来说存在问题，因为经常有报道称长新冠患者会出现运动和平衡症状。FND 的特征是出现看似与神经相关的症状，但缺乏与神经基质相符的症状。尽管根据 ICD-11 和 DSM-5-TR 的诊断分类主要依赖于排除任何其他可能导致这些症状的医学状况，但目前 FND 分类的神经科实践允许存在这种共病。因此，被误诊为 FND 的出现运动和平衡症状的长新冠患者不再能够接受长新冠治疗，而 FND 的治疗很少提供且效果不佳。针对潜在机制和诊断方法的研究应探讨如何确定目前诊断为 FND 的运动和平衡症状是否应被视为长新冠症状的一部分，换句话说，即症状表现的一部分，以及在哪些情况下它们正确代表 FND。需要对康复模型、治疗和综合护理进行研究，这应考虑到生物学基础以及可能的心理机制和患者视角。
