Vaccines and Functional Neurological Disorder: A Complex Story

Summary: A number of videos have surfaced on popular channels showing people experiencing some adverse effects following the coronavirus vaccine. Researchers say some of the cases could be related to functional neurological disorder, a common neuropsychological condition.

Source: Mass General

Videos of people experiencing severe neurological symptoms, including convulsions and difficulty walking, purportedly after receiving a COVID-19 vaccine, have surfaced on Facebook, YouTube and other social media channels. The millions of people watching these videos might conclude that the vaccine is either quite dangerous to produce such symptoms or that the people in the videos are faking their symptoms.

Both conclusions are incorrect, according to neurologist and psychiatrist David Perez, MD, MMSc, director of the Functional Neurological Disorders Unit at Massachusetts General Hospital (MGH).

In a JAMA Neurology Viewpoint, the authors explain that the COVID-19 vaccine may precipitate the development of functional neurological disorder (FND), a neuropsychiatric disorder with symptoms such as limb weakness, gait problems, jerky movements, tremor and facial spasms.

“The spread of these videos could fuel vaccine hesitancy by giving an overly simplistic impression of potential links between the vaccine and major neurological symptoms,” says Perez, the piece’s senior author. “Instead, these are symptoms of a real, brain-based disorder that sits at the intersection of neurology and psychiatry.”

Some, but not all, individuals vulnerable to developing FND may have experienced adverse life events or have chronic pain or a range of other medical or psychiatric conditions. Image is in the public domain

FND is a disruption in the brain’s normal mechanisms for controlling the body and can be triggered by physical or emotional events, including head injury, a medical or surgical procedure, and vaccinations. “Some people with FND have a heightened awareness of their body and increased state of arousal and threat, which may hijack normal neural networks controlling voluntary movements,” says Perez. “FND teaches us quite a bit about the complexities of the human brain.”

An individual’s awareness of motor control may also be impaired with FND, adds first author David Dongkyung Kim, MD, clinical fellow in Behavioral Neurology-Neuropsychiatry at MGH: “The body is moving, but the individual doesn’t experience a sense of agency over their movements, such as tremors or movements of the trunk.”

Some, but not all, individuals vulnerable to developing FND may have experienced adverse life events or have chronic pain or a range of other medical or psychiatric conditions. “The biopsychosocial model involving an interplay of risk factors, triggering events, and perpetuating factors is how we currently understand FND,” says Kim. FND can, however, be treated with education, physical rehabilitation and psychotherapy.

Neurologists and other health care professionals have an obligation to explain FND to the public, say the authors. “Helping people understand FND will bring this disorder into mainstream medical conversations, and transparently addressing concerns will better allow people to make informed decisions for themselves on receiving the COVID-19 vaccine,” says Perez.

Perez is an assistant professor of Neurology at Harvard Medical School. Candice Kung, MD, is a forensic psychiatry fellow at the University of Toronto.

About this neurology research news

Source: Mass General
Contact: Michael Morrison – Mass General
Image: The image is in the public domain

Original Research: Open access.
Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations: Lessons Learned From Functional Neurological Disorder” by David Dongkyung Kim et al. JAMA Neurology Viewpoint


Abstract

Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations: Lessons Learned From Functional Neurological Disorder

By the end of January 2021, more than 97.3 million doses globally and 31.8 million doses in the United States have been administered of the COVID-19 vaccine. 

Although important postmarketing surveillance is ongoing, it is currently highly effective and safe, with adverse effects including transient symptoms such as fever/chills, headache, fatigue, myalgia/arthralgia, lymphadenopathy, nausea, or local effects of swelling, erythema, or pain. 

With the public being vaccinated, there have recently been videos circulating on social media about major neurologic adverse events after administration of the COVID-19 vaccine. A few of these videos have been viewed millions of times by the public. Some depict individuals with continuous movements of the trunk and limbs or walking difficulties.

The spread of these videos has fueled vaccine hesitancy concerns and without effective communication by medical professionals to the public, this can lead to reduced vaccination rates and an unnecessary prolongation of the pandemic.

It must be noted that these videos may be unsubstantiated, and it is not definitively known if the COVID-19 vaccine was administered in these cases. However, it was reported in the news that at least 1 patient was told by their physician that the diagnosis was conversion disorder, also known as functional neurological disorder (FND).

Here, we provide context regarding potential associations between FND and COVID-19 vaccinations, as effective communication regarding this intersection is critically important.

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