Co-occurring functional neurological disorder and autism: an exploratory study of comorbidities in a retrospective cohort study using TriNetX.

IF 4.6 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Neurology Pub Date : 2025-09-25 DOI:10.1007/s00415-025-13385-6

Lily Smythe, Livia Asan, Timothy R Nicholson, Francesca Happé, Mark J Edwards

{"title":"Co-occurring functional neurological disorder and autism: an exploratory study of comorbidities in a retrospective cohort study using TriNetX.","authors":"Lily Smythe, Livia Asan, Timothy R Nicholson, Francesca Happé, Mark J Edwards","doi":"10.1007/s00415-025-13385-6","DOIUrl":null,"url":null,"abstract":"Background: Functional Neurological Disorder (FND) encompasses motor, cognitive, and sensory symptoms resulting from disruptions in brain-body communication. Emerging research suggests a higher-than-expected occurrence of autism in FND, potentially due to shared cognitive mechanisms and overlapping comorbidities. However, large-scale characterisation of this dual-diagnosis is lacking.Methods: Using de-identified health records from the TriNetX research network, we identified children and adults with both FND and autism ('FND + Autism'), comparing them to individuals with FND only ('FND-only') and autism only ('Autism-only'). We examined psychiatric comorbidities (e.g. mood, anxiety, post-traumatic stress disorder, personality disorders, obsessive-compulsive disorder), intellectual disability and ADHD.Results: Of 220,312 individuals with an FND diagnosis, and 674,971 individuals with an autism diagnosis, 5,152 (2.3% of FND, 0.76% of autism) had both FND and autism. The rates of autism were therefore 6 times higher in FND compared to the base rates of the TriNetX population. Most were diagnosed with autism before FND, with over one-third diagnosed in childhood. Functional seizures were the most common FND subtype, and were more frequent in FND + Autism than FND-only (adults: 52% vs. 44%; children: 47% vs. 42%). Comorbidity across all psychiatric conditions was significantly higher in FND + Autism compared to both comparison groups. ADHD was particularly elevated in FND + Autism (adults: 50% vs. 13% FND-only, 36% Autism-only; children: 64% vs. 21% FND-only, 41% Autism-only).Conclusions: This study presents the largest dataset to date characterising individuals with co-occurring FND and autism. Findings are consistent with previous findings of higher rates of autism in people with FND and reveal a potentially distinct clinical profile, marked by elevated rates of ADHD and psychiatric comorbidities, and increased occurrence of functional seizures compared to FND- or Autism-only groups. Recognising this overlap may improve diagnosis, clinical care, and understanding of mechanisms underlying the co-occurrence of FND and autism.","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 10","pages":"653"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464146/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00415-025-13385-6","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Functional Neurological Disorder (FND) encompasses motor, cognitive, and sensory symptoms resulting from disruptions in brain-body communication. Emerging research suggests a higher-than-expected occurrence of autism in FND, potentially due to shared cognitive mechanisms and overlapping comorbidities. However, large-scale characterisation of this dual-diagnosis is lacking.

Methods: Using de-identified health records from the TriNetX research network, we identified children and adults with both FND and autism ('FND + Autism'), comparing them to individuals with FND only ('FND-only') and autism only ('Autism-only'). We examined psychiatric comorbidities (e.g. mood, anxiety, post-traumatic stress disorder, personality disorders, obsessive-compulsive disorder), intellectual disability and ADHD.

Results: Of 220,312 individuals with an FND diagnosis, and 674,971 individuals with an autism diagnosis, 5,152 (2.3% of FND, 0.76% of autism) had both FND and autism. The rates of autism were therefore 6 times higher in FND compared to the base rates of the TriNetX population. Most were diagnosed with autism before FND, with over one-third diagnosed in childhood. Functional seizures were the most common FND subtype, and were more frequent in FND + Autism than FND-only (adults: 52% vs. 44%; children: 47% vs. 42%). Comorbidity across all psychiatric conditions was significantly higher in FND + Autism compared to both comparison groups. ADHD was particularly elevated in FND + Autism (adults: 50% vs. 13% FND-only, 36% Autism-only; children: 64% vs. 21% FND-only, 41% Autism-only).

Conclusions: This study presents the largest dataset to date characterising individuals with co-occurring FND and autism. Findings are consistent with previous findings of higher rates of autism in people with FND and reveal a potentially distinct clinical profile, marked by elevated rates of ADHD and psychiatric comorbidities, and increased occurrence of functional seizures compared to FND- or Autism-only groups. Recognising this overlap may improve diagnosis, clinical care, and understanding of mechanisms underlying the co-occurrence of FND and autism.

查看原文本刊更多论文

同时发生的功能性神经障碍和自闭症：一项使用TriNetX的回顾性队列研究中合并症的探索性研究。

背景：功能性神经障碍（FND）包括由脑-体交流中断引起的运动、认知和感觉症状。新兴研究表明，FND中自闭症的发生率高于预期，可能是由于共同的认知机制和重叠的合并症。然而，缺乏这种双重诊断的大规模特征。方法：使用来自TriNetX研究网络的去识别健康记录，我们确定了患有FND和自闭症（“FND +自闭症”）的儿童和成人，并将他们与仅患有FND（“FND-only”）和仅患有自闭症（“autism -only”）的个体进行比较。我们检查了精神合并症（如情绪、焦虑、创伤后应激障碍、人格障碍、强迫症）、智力残疾和多动症。结果：在220,312名确诊为FND的个体和674,971名确诊为自闭症的个体中，5152名（2.3%的FND， 0.76%的自闭症）同时患有FND和自闭症。因此，与TriNetX人群的基本比率相比，FND中自闭症的比率高出6倍。大多数人在FND之前被诊断为自闭症，超过三分之一的人在童年时被诊断出来。功能性癫痫发作是最常见的FND亚型，并且在FND +自闭症中比仅FND更常见（成人：52%对44%；儿童：47%对42%）。与两个对照组相比，FND +自闭症患者所有精神疾病的共病率明显更高。ADHD在FND +自闭症中尤为突出（成人：50% vs 13%， 36%；儿童：64% vs 21% FND， 41%自闭症）。结论：这项研究提供了迄今为止最大的数据集，描述了同时发生FND和自闭症的个体。研究结果与之前的发现一致，即FND患者的自闭症发病率更高，并揭示了潜在的独特临床特征，与FND或自闭症组相比，ADHD和精神合并症的发生率升高，以及功能性癫痫发作的发生率增加。认识到这种重叠可能会改善诊断、临床护理和对FND和自闭症同时发生的机制的理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.