Autonomic, Endocrine, and Inflammation Profiles in Functional Neurological Disorder: A Systematic Review and Meta-Analysis.
Autonomic, Endocrine, and Inflammation Profiles in Functional Neurological Disorder: A Systematic Review and Meta-Analysis.
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DOI：
10.1176/appi.neuropsych.21010025
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Perez DL
中科院分区：
文献类型：
--
作者：
Paredes-Echeverri S;Maggio J;Bègue I;Pick S;Nicholson TR;Perez DL
功能性神经障碍（FND）是一种核心的神经精神疾病。迄今为止，在FND患者中观察到有希望但不一致的神经回路概况，这表明我们在系统水平的神经生物学理解中仍然存在重要差距。因此，其他重要的生理变量，包括自主神经，内分泌和炎症的发现需要背景化的更完整的机制图片。在此，我们对FND的病例对照和队列研究进行了系统回顾和荟萃分析。检索了PubMed、PsycINFO和Embase数据库中1900年1月1日至2020年9月1日期间研究FND患者自主神经、内分泌和/或炎症标志物的研究。2,056份筛选记录中的66份纳入了代表1,699名患者的综述，荟萃分析中使用了23篇文章的数据。研究结果表明，与健康对照（HC）相比，FND儿童/青少年的静息心率增加;与HC相比，FND患者在整个生命周期内的静息心率变异性也有降低的趋势。在成人中，发作期心率将功能性癫痫发作与癫痫发作个体区分开来。FND患者的其他自主神经和内分泌特征是异质性的，有几项研究强调了个体差异的重要性。FND的炎症研究仍处于早期阶段。展望未来，需要使用更大的样本量来考虑功能性神经症状与行为，心理，自主神经，内分泌，炎症，神经影像和表观遗传/遗传数据之间的复杂相互作用。还需要更多的研究来确定FND是否在机制上（和病因学上）相似或不同的表型。
Functional neurological disorder (FND) is a core neuropsychiatric condition. To date, promising yet inconsistently identified neural circuit profiles have been observed in patients with FND, suggesting important gaps remain in our systems-level neurobiological understanding. As such, other important physiological variables including autonomic, endocrine and inflammation findings need to be contextualized for a more complete mechanistic picture. Here, we performed a systematic review and meta-analysis of available case-control and cohort studies in FND. PubMed, PsycINFO and Embase databases were searched from January 1, 1900 to September 1, 2020 for studies that investigated autonomic, endocrine and/or inflammation markers in patients with FND. Sixty-six of 2,056 screened records were included in the review representing 1,699 patients, with data from 23 articles used in meta-analyses. Findings show that children/adolescents with FND vs. healthy controls (HCs) have increased resting heart rate; there is also a tendency towards reduced resting heart rate variability in patients with FND across the lifespan vs. HCs. In adults, peri-ictal heart rate differentiated those with functional seizures from individuals with epileptic seizures. Other autonomic and endocrine profiles in patients with FND were heterogeneous, with several studies highlighting the importance of individual differences. Inflammation research in FND remains in its early stages. Moving forward, there is a need to use larger sample sizes to consider the complex interplay between functional neurological symptoms and behavioral, psychological, autonomic, endocrine, inflammation, neuroimaging and epigenetic/genetic data. More research is also needed to determine whether FND is mechanistically (and etiologically) similar or distinct across phenotypes.
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