Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/[FND], 2021, van der Feltz-Cornelis et al

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

Highlights

• 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.


Abstract

Background
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.

Aim
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.

Method
Feasibility study.

Results
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.

Conclusion
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.

Open access, https://www.sciencedirect.com/science/article/pii/S2666354621000314

 

Rubberstamps are always looking for papers to stamp on. This is the stuff that makes this field a joke.

 

Usual fixation on Adverse Childhood Events.

I haven't lived in Britain for many decades, so someone will have to explain how a "white British" child can be married without her consent.

 

@Hutan -- thank you for another very helpful quick comment --

To be on the safe side, perhaps add a [sarcasm] note behind your interpretation of the authors' perception of the patients/ patient involvement?

( I agree with your interpretation and think it's an illustrative example on how patient involvement should not be conceived.)

It seems the role of the actively involved patients was very limited:

"Lastly, we aimed to establish a patient and public involvement (PPI) advisory group to determine the acceptability of the study processes for patients and carers."

 

The researchers are being far more patronizing to patients than anything I've seen in biomedical ME research. I'd expect to see these remarks in a BPS paper but it's shocking to see in serious research.

 

Not a defence but ........... age range gives at least one person born late 50s so a teen in early 70s, there was still a lot of pressured marriages at that time - for many girls pregnancy meant either an unwanted marriage or adoption of child at birth, abortion may have been legal but still not easily available to many young women.

Also 70s still dark ages re: domestic violence so a 16 year old with a small child could find herself emotionally/socially forced into a toxic marriage from which she would have no practical means of escape, the first refuge in the UK was not established until 1971 by the heroic Erin Pizzey. So while a white British woman might not fit the profile of 'child marriage' or the forced by violence marriages seen in other countries or within some UK ethnic/religious minority communities there's still a possibility that she experienced a miserable marriage being forced on her.

What is forced marriage?
"A forced marriage is where one or both people do not or cannot consent to the marriage, and pressure or abuse is used to force them into marriage."

In addition to the lack of scientific rigour, I think there's major concern about how the participants are being used - by definition these are all people who have experienced trauma.

 

It's research on conversion disorder. That's not serious at all. Doesn't matter if they do advanced lab work or a summoning circle. It's junk regardless.