In the following weeks, she noticed gradual improvement in her symptoms and no longer required a cane for ambulation. We explained the diagnosis to her and offered FND-associated physiotherapy. Given the clinical findings and normal investigations, the patient received a diagnosis of functional neurologic disorder (FND) following SARS-CoV-2 vaccination. She was referred to our functional neurologic disorders clinic for further assessment. A normal electroencephalogram (EEG) showed no evidence of epileptiform activity.
A computed tomography (CT) venogram and magnetic resonance imaging (MRI) scans of her brain and cervical spine with contrast ruled out structural lesions, including venous sinus thrombosis. All laboratory investigations were normal.
The patient had been assessed previously at an emergency department, with consultation to general neurology to investigate potential causes of her acute-onset atypical movements. Her atypical movement patterns (with variability, distractibility and entrainment) were suggestive of a functional movement disorder. Her involuntary movements were pronounced during the physical examination, with “twitching” of her face during activation of her frontalis, and jerky movements of her arms during pronator drift. She reported no family history of any neurologic disorders. During childhood, she had had psychological trauma that would be considered an adverse childhood experience. She had no relevant medical history and no psychiatric history. She had no history of smoking, recreational drug use or substantial alcohol intake. She reported being stressed because of the pandemic and was initially hesitant to receive the SARS-CoV-2 vaccine, but had decided to get her first dose because she was employed in the education sector. In addition, she described fatigue, headache and intermittent paresthesia and pain in different parts of her body. The movements occurred intermittently during the day, lasting for seconds, but they affected her gait so that she required a cane to walk. These involuntary jerks progressed to involve the rest of her body. Treatment of FND includes appropriate delivery of the diagnosis, as well as patient education and multidisciplinary management.Ī healthy 50-year-old woman developed involuntary movements of her legs about 4 days after her first dose of vaccine against SARS-CoV-2. Patients who develop new-onset FND after vaccination may be hesitant to receive subsequent doses of SARS-CoV-2 vaccine, and patients with pre-existing FND or related disorders may be hesitant to receive any doses of the vaccine. No evidence exists to suggest a direct causal relationship between specific constituents in the SARS-CoV-2 vaccine and FND patients may develop FND after vaccination owing to a variety of complex and incompletely understood factors.
An increasing number of patients are presenting with functional neurologic disorders (FND) after SARS-CoV-2 vaccination.
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