JonStone, Professor of Neurology, Centre of Clinical Brain Sciences, University of Edinburgh (Edinburgh, UK)
AlanCarson, Professor of Neuropsychiatry, Centre of Clinical Brain Sciences, University of Edinburgh (Edinburgh, UK)
Submitted September 29, 2020
Avindra Nath’s article1 makes a welcome “call to arms” for neurologists to be interested in “long-haul COVID,” noting that many sufferers are “concerned that they could be stigmatized” as having a functional disorder. Research over the last 20 years has shown that functional disorders have their own neurobiology, they are commonly precipitated by physical experiences such as injury and (any kind of) infection, and they can affect anyone regardless of education or prior medical history.2 Functional disorders are genuine conditions, not synonyms for “nothing wrong” or “nothing biological.” The investigation of long-haul COVID should not be polarized at the outset by a false dichotomy between “biology” and “functional disorders.” We now have positive diagnostic features for functional neurological disorders involving motor and seizure symptoms, and increasingly for cognitive symptoms.3 Including these in phenotypic studies—especially as comorbidities—may help improve our understanding of long-haul covid and other post-viral syndromes.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Nath A. Long-Haul Covid. Neurology 2020 Epub Aug 11.
Espay AJ, Aybek S, Carson A, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol 2018;75:1132.
Ball HA, McWhirter L, Ballard C, et al. Functional cognitive disorder: dementia’s blind spot. Brain 2020 Epub Aug 13.
Avindra Nath’s article1 makes a welcome “call to arms” for neurologists to be interested in “long-haul COVID,” noting that many sufferers are “concerned that they could be stigmatized” as having a functional disorder. Research over the last 20 years has shown that functional disorders have their own neurobiology, they are commonly precipitated by physical experiences such as injury and (any kind of) infection, and they can affect anyone regardless of education or prior medical history.2 Functional disorders are genuine conditions, not synonyms for “nothing wrong” or “nothing biological.” The investigation of long-haul COVID should not be polarized at the outset by a false dichotomy between “biology” and “functional disorders.” We now have positive diagnostic features for functional neurological disorders involving motor and seizure symptoms, and increasingly for cognitive symptoms.3 Including these in phenotypic studies—especially as comorbidities—may help improve our understanding of long-haul covid and other post-viral syndromes.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References