Functional Neurological Disorder and How It Relates to COVID-19 Vaccines

Increased education about and attention to functional neurological disorder (FND) is needed in order to make vaccination programs, like for COVID-19, more successful, according to a viewpoint article published in JAMA Neurology.

As of January of 2021, 97.3 million doses of the COVID-19 vaccine have been administered. These vaccines have been highly effective and safe, with some adverse reactions including fever, fatigue, nausea, and injection site pain.

Recently, videos have been circulating online which discuss major neurologic adverse events, such as continuous movements of the limbs and trunk or difficulties walking, following COVID-19 vaccination. Some of these videos have been viewed millions of times and have likely driven vaccine hesitancy.

In at least 1 case reported on the news, a physician associated these symptoms with FND or conversion disorder. The Functional Neurological Disorder Society issued a statement which indicated that the features depicted in this video seemed to be consistent with FND.

The authors of this viewpoint commentary highlighted the fact that FND is among the most commonly observed conditions in the outpatient neurology setting and can be unrelated to vaccination.

FND is a brain-based disorder characterized by the development of a range of neurological symptoms exacerbated by biological, psychological, and/or environmental factors. FND may be triggered by physically/emotionally taxing events such as injury, medical or surgical procedure, or vaccination. Instead of being directly caused by these events, factors including expectations, beliefs, arousal, and emotional processing may play a mechanistic role in the pathophysiology of this disorder.

The treatment for FND comprises education about the disorder, physical rehabilitation, and cognitive behavioral therapy. These approaches seek to retrain the brain to revert to automatic movement and to provide patients with coping strategies which aid in lowering arousal states.

The commentary authors concluded that physicians should explain the nature of FND, noting that these symptoms are real but not the directly caused by vaccine effects. They added, “Transparency and effective communication are needed in our society more than ever, and a condition as prevalent and potentially debilitating as FND can no longer remain marginalized and in the shadows. Effective communication will help educate the public and reduce fears so that patients can make informed decisions for themselves on receiving the vaccine to reduce the risk of COVID-19.”

Reference

Kim DD, Kung CS, Perez DL. Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations: Lessons Learned From Functional Neurological Disorder. JAMA Neurol. Published online April 9, 2021. doi:10.1001/jamaneurol.2021.1042