TY - JOUR
T1 - Blood CRP levels are elevated in children and adolescents with functional neurological symptom disorder
AU - Kozlowska, Kasia
AU - Chung, Jason
AU - Cruickshank, Bronya
AU - McLean, Loyola
AU - Scher, Stephen
AU - Dale, Russell C.
AU - Mohammad, Shekeeb S.
AU - Singh‑Grewal, Davinder
AU - Prabhuswamy, Mukesh Yajaman
AU - Patrick, Ellis
PY - 2019
Y1 - 2019
N2 - There is accumulating evidence that patients with functional neurological symptom disorder (FND) show activation of multiple components of the stress system"”the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and brain regions involved in arousal- and emotion-processing. This study aims to examine whether the immune-inflammatory component of the stress system is also activated. C-reactive protein (CRP) blood titre levels were measured in 79 children and adolescents with FND. CRP values"‰â‰¥"‰2 mg/L suggest low-grade inflammation. CRP values"‰>"‰10 mg/L suggest a disease process. Sixty-six percent of subjects (n"‰="‰52) had CRP titres"‰â‰¥"‰2 mg/L. The upward shift in the distribution of CRP levels suggested low-grade inflammation (median CRP concentration was 4.60 mg/L, with 75th and 90th percentiles of 6.1 and 10.3 mg/L, respectively). Elevated CRP titres were not explained by sex, pubertal status, BMI, or medical factors. Confounder analyses suggested that history of maltreatment (χ2"‰="‰2.802, df"‰="‰1, p"‰="‰0.094, φ"‰="‰0.190; β"‰="‰2.823, p"‰="‰0.04) and a diagnosis of anxiety (χ2"‰="‰2.731, df"‰="‰1, p"‰="‰0.098, φ"‰="‰0.187; β"‰="‰4.520, p"‰="‰0.061) contributed to elevated CRP levels. Future research will need to identify the origins and locations of immune cell activation and the pathways and systems contributing to their activation and modulation. Because functional activity in neurons and glial cells"”the brain's innate effector immune cells"”is tightly coupled, our finding of elevated CRP titres suggests activation of the immune-inflammatory component of the brain's stress system. A more direct examination of inflammation-related molecules in the brain will help clarify the role of immune-inflammatory processes in FND.
AB - There is accumulating evidence that patients with functional neurological symptom disorder (FND) show activation of multiple components of the stress system"”the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and brain regions involved in arousal- and emotion-processing. This study aims to examine whether the immune-inflammatory component of the stress system is also activated. C-reactive protein (CRP) blood titre levels were measured in 79 children and adolescents with FND. CRP values"‰â‰¥"‰2 mg/L suggest low-grade inflammation. CRP values"‰>"‰10 mg/L suggest a disease process. Sixty-six percent of subjects (n"‰="‰52) had CRP titres"‰â‰¥"‰2 mg/L. The upward shift in the distribution of CRP levels suggested low-grade inflammation (median CRP concentration was 4.60 mg/L, with 75th and 90th percentiles of 6.1 and 10.3 mg/L, respectively). Elevated CRP titres were not explained by sex, pubertal status, BMI, or medical factors. Confounder analyses suggested that history of maltreatment (χ2"‰="‰2.802, df"‰="‰1, p"‰="‰0.094, φ"‰="‰0.190; β"‰="‰2.823, p"‰="‰0.04) and a diagnosis of anxiety (χ2"‰="‰2.731, df"‰="‰1, p"‰="‰0.098, φ"‰="‰0.187; β"‰="‰4.520, p"‰="‰0.061) contributed to elevated CRP levels. Future research will need to identify the origins and locations of immune cell activation and the pathways and systems contributing to their activation and modulation. Because functional activity in neurons and glial cells"”the brain's innate effector immune cells"”is tightly coupled, our finding of elevated CRP titres suggests activation of the immune-inflammatory component of the brain's stress system. A more direct examination of inflammation-related molecules in the brain will help clarify the role of immune-inflammatory processes in FND.
KW - conversion disorder
KW - diseases
KW - inflammation
KW - nervous system
KW - spasms
UR - http://handle.westernsydney.edu.au:8081/1959.7/uws:48100
U2 - 10.1007/s00787-018-1212-2
DO - 10.1007/s00787-018-1212-2
M3 - Article
SN - 1018-8827
VL - 28
SP - 491
EP - 504
JO - European Child and Adolescent Psychiatry
JF - European Child and Adolescent Psychiatry
IS - 4
ER -