Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study

Conversion disorder/functional neurological disorder (CD/FND) occurs often in neurological settings and can lead to long-term distress, disability and demand on health care services. Systemic low-grade inflammation might play a role, however, the pathogenic mechanism is still unknown. 1) To explore...

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Published in:	Brain, behavior, & immunity. Health behavior, & immunity. Health, 2021-05, Vol.13, p.100228-100228, Article 100228
Main Authors:	van der Feltz-Cornelis, Christina, Brabyn, Sally, Ratcliff, Jonathan, Varley, Danielle, Allgar, Victoria, Gilbody, Simon, Clarke, Chris, Lagos, Dimitris
Format:	Article
Language:	eng
Subjects:	Childhood adverse experiences (ACE) Conversion disorder/functional neurological disorder Cytokines Epigenetic mechanism Feasibility study Full Length Functional movement disorder microRNA Neurocognitive symptoms Systemic low-grade inflammation
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Summary:	Conversion disorder/functional neurological disorder (CD/FND) occurs often in neurological settings and can lead to long-term distress, disability and demand on health care services. Systemic low-grade inflammation might play a role, however, the pathogenic mechanism is still unknown. 1) To explore the feasibility to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI). 2) To generate proof of concept regarding a possible role for cytokines, microRNA, cortisol levels and neurocognitive symptoms in patients with motor CD/FND. Feasibility study. The study showed active involvement of patients despite high clinical illness burden and disability, neurocognitive symptoms, childhood adverse experiences (ACE) and current life events. The study provided valuable knowledge regarding the feasibility of conducting a study in these patients that will inform future study phases. In the sample there were elevated levels of IL6, IL12, IL17A, IFNg, TNFa and VEGF-a, suggesting systemic low-grade inflammation. Also, microRNAs involved in inflammation and vascular inflammation were correlated with TNFa and VEGFa respectively, suggesting proof of concept for an epigenetic mechanism. Owing to the COVID-19 outbreak, the patient sample was limited to 15 patients. It is a novelty that this study is conducted in the clinical setting. This innovative, translational study explores stress-related SLI in CD/FND patients and the feasibility of a larger project aiming to develop new treatments for this vulnerable population. Given the positive findings, there is scope to conduct further research into the mechanism of disease in CD/FND. •It is feasible to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI).•IL6, TNFa, IFNg, TNFa, IL12 and IL17A are significantly higher than normal in CD/FND patients.•VEGF-a is significantly lower, suggesting a lack of vascular and neuronal support.•TNFa correlated with microRNA associated with inflammation (miR-146a and miR-155). This suggests an epigenetic mechanism.•VEGFa correlated with miR-21 and miR-132, suggesting an epigenetic mechanism associated with vascular inflammation.
ISSN:	2666-3546 2666-3546