COVID 19 and Functional Neurological Disorders in Children and Adolescents
Dear Editor
The effect of COVID 19 on the mental health of children and young people has been quite significant as brought out in the article ‘Mental health and wellbeing of children and adolescents during the covid-19 pandemic’ by Rider et al (1).
It has been observed that there has been a significant increase in children and young people presenting with Functional Neurological Disorders (FND). We had observed that there had been an increase in the presentation of tics and tic like movement symptoms and seizure like attacks in our clinics during the course of this pandemic. Interestingly we became aware that this phenomenon had been noted widely (2). Pringsheim et al had noted rapid onset functional tic like behaviours in adolescent females in a world wide study across eight centres (3).
FND is a condition in which there is a disorder with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process. FND can present with a wide variety of neurological symptoms, such as limb weakness, sensory disturbances, movements or seizures. Conventional tests such as MRI brain scans and EEGs are usually normal in patients with FND. This has led, historically, to the condition being relatively neglected by both clinicians and researchers. However, it is now established that FND is a common cause of disability and distress, which may overlap with other problems such as chronic pain and fatigue. Studies support that FND is potentially reversible with specifically tailored physical, psychological and medical management strategies (4).
FND is currently classified as Conversion Disorder in the DSM-5 and ICD-10 classification of mental and behavioural disorders. Historically called Hysteria, the ‘hysterical symptoms’ were seen to be derived from undischarged "memories" connected to "psychical traumas." These memories were conjectured to originate when the nervous system was in a special physiological condition or "hypnoid state"; they were then postulated to remain cut off or dissociated from consciousness. Hysterical symptoms were said to result from the ‘intrusion’ of this second state into the somatic innervation, a mind-to-body process. Freud and Breuer termed this "conversion. (5).
This perhaps allows us to speculate on what may be underlying the current increase in the incidence of FND especially in children and young people particularly adolescent females. Psychical trauma or a perceived trauma, separation from social cohesion due to a combination of the illness itself and social containment measures such as social distancing and isolation and a fear psychosis or mass formation effect may need to be considered as possible contributing factors. The role of social medial cannot be overemphasised especially during this heightened emotional situation having an effect on the collective psyche.
A lot of further careful observation and research would be required to understand the effects of the current situation and develop clear strategies to reduce the burden of impairment affecting much of the child’s or young person’s family, social, educational and personal life not only from a health and wellbeing point of view but also inform policy as this is most importantly about our future generation and the society we want to build.
References:
(1) Rider, E. A., Ansari, E., Varrin, P. H., & Sparrow, J. (2021). Mental health and wellbeing of children and adolescents during the covid-19 pandemic. bmj, 374.
(2) Heyman, I., Liang, H., & Hedderly, T. (2021). COVID-19 related increase in childhood tics and tic-like attacks. Archives of Disease in Childhood, 106(5), 420-421.
(3) Pringsheim, T., Ganos, C., McGuire, J. F., Hedderly, T., Woods, D., Gilbert, D. L., ... & Martino, D. (2021). Rapid onset functional tic‐like behaviors in young females during the COVID‐19 pandemic. Movement Disorders.
(4) Stone, J. (2016). Functional neurological disorders: the neurological assessment as treatment. Practical Neurology, 16(1), 7-17.
(5) Owens, C., & Dein, S. (2006). Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment, 12(2), 152-157.
Rapid Response:
COVID 19 and Functional Neurological Disorders in Children and Adolescents
Dear Editor
The effect of COVID 19 on the mental health of children and young people has been quite significant as brought out in the article ‘Mental health and wellbeing of children and adolescents during the covid-19 pandemic’ by Rider et al (1).
It has been observed that there has been a significant increase in children and young people presenting with Functional Neurological Disorders (FND). We had observed that there had been an increase in the presentation of tics and tic like movement symptoms and seizure like attacks in our clinics during the course of this pandemic. Interestingly we became aware that this phenomenon had been noted widely (2). Pringsheim et al had noted rapid onset functional tic like behaviours in adolescent females in a world wide study across eight centres (3).
FND is a condition in which there is a disorder with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process. FND can present with a wide variety of neurological symptoms, such as limb weakness, sensory disturbances, movements or seizures. Conventional tests such as MRI brain scans and EEGs are usually normal in patients with FND. This has led, historically, to the condition being relatively neglected by both clinicians and researchers. However, it is now established that FND is a common cause of disability and distress, which may overlap with other problems such as chronic pain and fatigue. Studies support that FND is potentially reversible with specifically tailored physical, psychological and medical management strategies (4).
FND is currently classified as Conversion Disorder in the DSM-5 and ICD-10 classification of mental and behavioural disorders. Historically called Hysteria, the ‘hysterical symptoms’ were seen to be derived from undischarged "memories" connected to "psychical traumas." These memories were conjectured to originate when the nervous system was in a special physiological condition or "hypnoid state"; they were then postulated to remain cut off or dissociated from consciousness. Hysterical symptoms were said to result from the ‘intrusion’ of this second state into the somatic innervation, a mind-to-body process. Freud and Breuer termed this "conversion. (5).
This perhaps allows us to speculate on what may be underlying the current increase in the incidence of FND especially in children and young people particularly adolescent females. Psychical trauma or a perceived trauma, separation from social cohesion due to a combination of the illness itself and social containment measures such as social distancing and isolation and a fear psychosis or mass formation effect may need to be considered as possible contributing factors. The role of social medial cannot be overemphasised especially during this heightened emotional situation having an effect on the collective psyche.
A lot of further careful observation and research would be required to understand the effects of the current situation and develop clear strategies to reduce the burden of impairment affecting much of the child’s or young person’s family, social, educational and personal life not only from a health and wellbeing point of view but also inform policy as this is most importantly about our future generation and the society we want to build.
References:
(1) Rider, E. A., Ansari, E., Varrin, P. H., & Sparrow, J. (2021). Mental health and wellbeing of children and adolescents during the covid-19 pandemic. bmj, 374.
(2) Heyman, I., Liang, H., & Hedderly, T. (2021). COVID-19 related increase in childhood tics and tic-like attacks. Archives of Disease in Childhood, 106(5), 420-421.
(3) Pringsheim, T., Ganos, C., McGuire, J. F., Hedderly, T., Woods, D., Gilbert, D. L., ... & Martino, D. (2021). Rapid onset functional tic‐like behaviors in young females during the COVID‐19 pandemic. Movement Disorders.
(4) Stone, J. (2016). Functional neurological disorders: the neurological assessment as treatment. Practical Neurology, 16(1), 7-17.
(5) Owens, C., & Dein, S. (2006). Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment, 12(2), 152-157.
Competing interests: No competing interests