Case Report: Overlap Between Long COVID and Functional Neurological Disorders, 2022, Gilio et al

[Andy]

Long lasting symptoms have been reported in a considerable proportion of patients after a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. This condition, defined as either “post-acute coronavirus disease (COVID),” “long COVID,” or “long-haul COVID,” has also been described in outpatients and in individuals who are asymptomatic during the acute infection. A possible overlap exists between this condition and the functional neurological disorders (FNDs).

We report a 23-year-old man who developed, after asymptomatic COVID-19, a complex symptomatology characterized by fatigue, episodic shortness of breath, nocturnal tachycardia, and chest pain. He also complained of attention and memory difficulties, fluctuating limb dysesthesia, and weakness of his left arm. After neurological examination, a diagnosis of FND was made. Notably, the patient was also evaluated at a post-COVID center and received a diagnosis of long COVID-19 syndrome. After 4 months of psychoanalytic psychotherapy and targeted physical therapy in our center for FNDs, dysesthesia and motor symptoms had resolved, and the subjective cognitive complaints had improved significantly. However, the patient had not fully recovered as mild symptoms persisted limiting physical activities. Long-term post COVID symptoms and FNDs may share underlying biological mechanisms, such as stress and inflammation.

Our case suggests that functional symptoms may coexist with the long COVID symptoms and may improve with targeted interventions. In patients presenting with new fluctuating symptoms after SARS-CoV-2 infection, the diagnosis of FNDs should be considered, and the positive clinical signs should be carefully investigated.

Open access, https://www.frontiersin.org/articles/10.3389/fneur.2021.811276/full

 

[Arnie Pye]

We report a 23-year-old man who developed, after asymptomatic COVID-19, a complex symptomatology characterized by fatigue, episodic shortness of breath, nocturnal tachycardia, and chest pain. He also complained of attention and memory difficulties, fluctuating limb dysesthesia, and weakness of his left arm.

I had all those symptoms, although my arm weakness affected both arms. In my case it was caused by very severe iron deficiency, and probably hypovolaemia too since I had a pronounced GI bleed at the time.

 

[InitialConditions]

After 4 months of psychoanalytic psychotherapy and targeted physical therapy in our center for FNDs, dysesthesia and motor symptoms had resolved, and the subjective cognitive complaints had improved significantly. However, the patient had not fully recovered as mild symptoms persisted limiting physical activities.

Or maybe he improved naturally with time, like most people after an infection.

 

[Mithriel]

I do not doubt that many people with longcovid could easily be diagnosed as having FND but not because of their symptoms but because FND doctors believe that all symptoms are part of FND.

Their "opt-in" tests are a bit dodgy but the biggest problem is that they may be detecting something but they offer no evidence, or theory for that matter, of why the test is positive.

In the examination the person will not be able to move the weak leg, but when they are asked to make a hip flexion movement with the good leg, the doctor will be able to feel that the power in the weak leg comes back. This is a sign called “Hoover's sign”.

And CBT will cure it all!

As an aside I can believe that intensive physio can be useful. It works for stroke victims and my friend with cerebral palsy regained better functioning with regular physiotherapy. (Unfortunately she lost that function as soon as she was discharged with a set of exercises. It was the hands on manipulation that did the job)