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Advanced Neurology POTS with tics versus tic-like behaviors

fear conditioning might exacerbate symptoms, it does patients with POTS and functional neurological disorder,
not necessarily account as the only responsible factor since our clinical populations were recruited at a single
for the initial development of POTS. Once again, the specialist center. Moreover, our research predominantly
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implementation of a biopsychosocial model provides a relied on a retrospective analysis of medical records,
comprehensive framework for the clinical characterization which inherently limits the scope of variables that could
and management of the heterogeneous group of people be investigated as part of the clinical correlates of POTS
with this condition. in patients with functional tic-like behaviors. Finally, the
diagnosis of functional tic-like behaviors was corroborated
The association between POTS (and other autonomic
disorders) and functional neurological disorders was by the ESSTS criteria, but it has recently been pointed out
that such criteria inevitably involve a degree of circular
recently questioned by Blitshteyn et al., based on reasoning – which is likely to be shared by any operational
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differences in diagnostic criteria, pathophysiological criteria for the diagnosis of functional neurological
mechanisms, and treatment interventions. Specifically, disorders. Despite these limitations, our study makes a
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these authors highlighted the prominent role of contribution to the growing body of evidence regarding the
pharmacotherapy for common autonomic disorders as comorbidity profiles of patient with POTS, with focus on
opposed to the focus on psychotherapy and physical therapy the interface between POTS and the multiple phenotypes
for patients with functional neurological symptoms. In of functional neurological disorder. Specifically, a
cases where a patient meets the diagnostic criteria for both better understanding of the clinical characteristics and
disorders, their recommendation is to treat POTS first with comorbidity profiles of patients with POTS and patients
appropriate pharmacological and non-pharmacological with functional tic-like behaviors has the potential to
treatments, before implementing therapy for the functional improve the diagnostic accuracy of healthcare providers
neurological symptoms. The exact extent to which POTS dealing with these conditions. Our preliminary findings
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and functional neurological disorder interact as comorbid may therefore influence clinical practice by providing
conditions with overlapping but distinct mechanisms is additional information for the assessment protocols of
still poorly understood, highlighting the complexity of patients presenting with selected phenotypes of functional
brain-behavior interfaces. neurological disorders.
In our sample, the notable absence of functional Moreover, researchers investigating the pathophysiology
tic-like behaviors that were likely to be influenced by and clinical presentations of both POTS and functional
popular culture or social interactions possibly reveals the neurological disorder might be informed by these results.
existence of a distinct sub-phenotype of this condition. Further research is needed to shed more light on the
Another interesting finding of our study is that all patients intricate relationship between POTS and functional
presenting with both functional tic-like behaviors and neurological disorder. In particular, our preliminary
symptoms of POTS had been formally assessed and findings should be validated in future studies involving
diagnosed with high-functioning ASD (formerly referred culturally diverse populations, monitoring a broader range
to as Asperger syndrome). A recent prospective cohort of demographic and clinical variables, and employing
study demonstrated a high frequency of ASD in children prospective data collection methods. Longitudinal data
and young people with a wide range of functional would also provide useful insights into the long-term
neurological disorders. As part of the methodology of this prognosis of these conditions, including the possible
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study, clinician-confirmed diagnoses for both conditions presence of modifiable outcome predictors. There is a clear
were obtained, and its findings indicated that patients with need for further research exploring the neurobiological
functional neurological symptoms were 3 – 11 times more underpinnings of both POTS and functional neurological
likely to have ASD than the general pediatric population. disorder, to investigate the possibility of shared elements
Little is known about the possible association between in their pathophysiological underpinnings. Finally, clinical
POTS and ASD, but preliminary evidence suggests that and experimental data would provide key information
intermittent neuro-cardiovascular autonomic dysfunction to facilitate the development of more personalized care
affecting heart rate and blood pressure could be over- pathways to address the healthcare needs of challenging
represented in patients with ASD. 60 clinical populations.
A few notable limitations need to be taken into
account when interpreting the findings of the present 5. Conclusion
study. The study was characterized by a relatively large Since the COVID-19 pandemic, the list of clinical
sample size; however, referral bias might have limited the phenotypes of functional movement disorders has
generalizability of our findings to the wider community of expanded to include functional tic-like behaviors.
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Volume 4 Issue 2 (2025) 107 doi: 10.36922/an.8525