{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T11:23:35Z","timestamp":1778671415639,"version":"3.51.4"},"reference-count":141,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T00:00:00Z","timestamp":1722211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Long COVID is a common sequela of SARS-CoV-2 infection. Data from numerous scientific studies indicate that long COVID involves a complex interaction between pathophysiological processes. Long COVID may involve the development of new diagnosable health conditions and exacerbation of pre-existing health conditions. However, despite this rapidly accumulating body of evidence regarding the pathobiology of long COVID, psychogenic and functional interpretations of the illness presentation continue to be endorsed by some healthcare professionals, creating confusion and inappropriate diagnostic and therapeutic pathways for people living with long COVID. The purpose of this perspective is to present a clinical and scientific rationale for why long COVID should not be considered as a functional neurologic disorder. It will begin by discussing the parallel historical development of pathobiological and psychosomatic\/sociogenic diagnostic constructs arising from a common root in neurasthenia, which has resulted in the collective understandings of myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS) and functional neurologic disorder (FND), respectively. We will also review the case definition criteria for FND and the distinguishing clinical and neuroimaging findings in FND vs. long COVID. We conclude that considering long COVID as FND is inappropriate based on differentiating pathophysiologic mechanisms and distinguishing clinical findings.<\/jats:p>","DOI":"10.3390\/jpm14080799","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T11:11:25Z","timestamp":1722337885000},"page":"799","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Long COVID Is Not a Functional Neurologic Disorder"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5772-7727","authenticated-orcid":false,"given":"Todd E.","family":"Davenport","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, University of the Pacific, Stockton, CA 95211, USA"},{"name":"Workwell Foundation, Santa Rosa, CA 95403, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3982-2031","authenticated-orcid":false,"given":"Svetlana","family":"Blitshteyn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14203, USA"},{"name":"Dysautonomia Clinic, Williamsville, NY 14221, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4513-2889","authenticated-orcid":false,"given":"Nicola","family":"Clague-Baker","sequence":"additional","affiliation":[{"name":"School of Allied Health Professions and Nursing, Institute of Population Health, University of Liverpool, Liverpool L69 7ZX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3949-799X","authenticated-orcid":false,"given":"David","family":"Davies-Payne","sequence":"additional","affiliation":[{"name":"Department of Radiology, Starship Children\u2019s Hospital, Auckland 1023, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4578-6150","authenticated-orcid":false,"given":"Glenn J.","family":"Treisman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah F.","family":"Tyson","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of Manchester, Manchester M14 4PX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1056\/NEJM186904290801301","article-title":"Neurasthenia, or nervous exhaustion","volume":"3","author":"Beard","year":"1869","journal-title":"Boston Med. Surg. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1212\/WNL.57.3.510","article-title":"Poor Beard!! Charcot\u2019s internationalization of neurasthenia, the \u201cAmerican disease\u201d","volume":"57","author":"Goetz","year":"2001","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1136\/bmj.38933.585764.AE","article-title":"Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: Prospective cohort study","volume":"333","author":"Hickie","year":"2006","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"387","DOI":"10.7326\/0003-4819-108-3-387","article-title":"Chronic fatigue syndrome: A working case definition","volume":"108","author":"Holmes","year":"1988","journal-title":"Ann. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/j.micinf.2003.07.002","article-title":"Diagnostic evaluation of 2\u2032, 5\u2032-oligoadenylate synthetase activities and antibodies against Epstein-Barr virus and Coxiella burnetii in patients with chronic fatigue syndrome in Japan","volume":"5","author":"Ikuta","year":"2003","journal-title":"Microbes Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1128\/jcm.28.6.1403-1410.1990","article-title":"Immunologic abnormalities in chronic fatigue syndrome","volume":"28","author":"Klimas","year":"1990","journal-title":"J. Clin. Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1016\/S1386-6532(06)70009-9","article-title":"Use of valganciclovir in patients with elevated antibody titers against Human Herpesvirus-6 (HHV-6) and Epstein-Barr Virus (EBV) who were experiencing central nervous system dysfunction including long-standing fatigue","volume":"37","author":"Kogelnik","year":"2006","journal-title":"J. Clin. Virol."},{"key":"ref_8","first-page":"101","article-title":"IgM serum antibodies to Epstein-Barr virus are uniquely present in a subset of patients with the chronic fatigue syndrome","volume":"18","author":"Lerner","year":"2004","journal-title":"In Vivo"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3682","DOI":"10.1002\/jmv.25744","article-title":"Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"92","author":"Shikova","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kasimir, F., Toomey, D., Liu, Z., Kaiping, A.C., Ariza, M.E., and Prusty, B.K. (2022). Tissue specific signature of HHV-6 infection in ME\/CFS. Front. Mol. Biosci., 9.","DOI":"10.3389\/fmolb.2022.1044964"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1348\/174866407X218312","article-title":"Neurocognitive and functional outcomes in persons recovering from West Nile virus illness","volume":"2","author":"Sejvar","year":"2008","journal-title":"J. Neuropsychol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Prevail III Study Group, Sneller, M.C., Reilly, C., Badio, M., Bishop, R.J., Eghrari, A.O., Moses, S.J., Johnson, K.L., Gayedyu-Dennis, D., and Hensley, L.E. (2019). A longitudinal study of Ebola sequelae in Liberia. N. Engl. J. Med., 380, 924\u2013934.","DOI":"10.1056\/NEJMoa1805435"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/S1473-3099(22)00127-X","article-title":"Clinical sequelae among individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease in Liberia: A longitudinal cohort study","volume":"22","author":"Kelly","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1136\/jcp.2004.020255","article-title":"The role of enterovirus in chronic fatigue syndrome","volume":"58","author":"Chia","year":"2005","journal-title":"J. Clin. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1136\/jcp.2007.050054","article-title":"Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach","volume":"61","author":"Chia","year":"2008","journal-title":"J. Clin. Pathol."},{"key":"ref_16","first-page":"CS88","article-title":"Chronic fatigue syndrome after Q fever","volume":"13","author":"Ledina","year":"2007","journal-title":"Med. Sci. Monit."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1159\/000008144","article-title":"Chronic fatigue syndrome in patients with Lyme borreliosis","volume":"43","author":"Treib","year":"2000","journal-title":"Eur. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Fares-Medina, S., Diaz-Caro, I., Garcia-Montes, R., Corral-Liria, I., and Garcia-Gomez-Heras, S. (2022). Multiple Chemical Sensitivity Syndrome: First symptoms and evolution of the clinical picture: Case-control study\/epidemiological case-control study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192315891"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1370\/afm.1346","article-title":"Chemical intolerance in primary care settings: Prevalence, comorbidity, and outcomes","volume":"10","author":"Katerndahl","year":"2012","journal-title":"Ann. Fam. Med."},{"key":"ref_20","unstructured":"National Academies of Sciences, Engineering, and Medicine (2024). A Long COVID Definition: A Chronic, Systemic Disease State with Profound Consequences, The National Academies Press."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1093\/infdis\/jiac136","article-title":"Global Prevalence of Post COVID-19 Condition or long COVID: A meta-analysis and systematic review","volume":"226","author":"Chen","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1038\/s41591-023-02521-2","article-title":"Postacute sequelae of COVID-19 at 2 years","volume":"29","author":"Bowe","year":"2023","journal-title":"Nat. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1038\/s41591-024-02987-8","article-title":"Three-year outcomes of post-acute sequelae of COVID-19","volume":"30","author":"Cai","year":"2024","journal-title":"Nat. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101019","DOI":"10.1016\/j.eclinm.2021.101019","article-title":"Characterizing long COVID in an international cohort: 7 months of symptoms and their impact","volume":"38","author":"Davis","year":"2021","journal-title":"eClinicalMedicine"},{"key":"ref_26","first-page":"183","article-title":"Posttreatment Lyme disease syndrome and myalgic encephalomyelitis\/chronic fatigue syndrome: A systematic review and comparison of pathogenesis","volume":"9","author":"Bai","year":"2023","journal-title":"Chronic Dis. Transl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ruiz-Pablos, M., Paiva, B., Montero-Mateo, R., Garcia, N., and Zabaleta, A. (2021). Epstein-Barr Virus and the origin of myalgic encephalomyelitis or chronic fatigue syndrome. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.656797"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1080\/21642850.2013.869176","article-title":"Predictors of post-infectious chronic fatigue syndrome in adolescents","volume":"2","author":"Jason","year":"2014","journal-title":"Health Psychol. Behav. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/neurolint15010001","article-title":"ME\/CFS and post-exertional malaise among patients with long COVID","volume":"15","author":"Jason","year":"2022","journal-title":"Neurol. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"pzac005","DOI":"10.1093\/ptj\/pzac005","article-title":"Chronic fatigue and postexertional malaise in people living with long COVID: An observational study","volume":"102","author":"Twomey","year":"2022","journal-title":"Phys. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.3233\/WOR-220581","article-title":"Post-exertional malaise among people with long COVID compared to myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS)","volume":"74","author":"Vernon","year":"2023","journal-title":"Work"},{"key":"ref_32","first-page":"59","article-title":"COVID-19 symptoms over time: Comparing long-haulers to ME\/CFS","volume":"9","author":"Jason","year":"2021","journal-title":"Fatigue"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Tokumasu, K., Honda, H., Sunada, N., Sakurada, Y., Matsuda, Y., Yamamoto, K., Nakano, Y., Hasegawa, T., Yamamoto, Y., and Otsuka, Y. (2022). Clinical characteristics of myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS) diagnosed in patients with long COVID. Medicina, 58.","DOI":"10.3390\/medicina58070850"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/10398562231222809","article-title":"Long COVID\u2014Can we deny a diagnosis without denying a person\u2019s reality?","volume":"32","author":"Little","year":"2024","journal-title":"Australas. Psychiatry"},{"key":"ref_35","first-page":"447","article-title":"Neurasthenia, myalgic encephalitis or cryptogenic chronic fatigue syndrome?","volume":"88","author":"Leitch","year":"1995","journal-title":"QJM"},{"key":"ref_36","unstructured":"Gilliam, A.G. (1934). Epidemiological Study on an Epidemic, Diagnosed as Poliomyelitis, Occurring among the Personnel of Los Angeles County General Hospital during the Summer of 1934, United States Government Printing Office."},{"key":"ref_37","first-page":"222","article-title":"A disease epidemic in Iceland simulating poliomyelitis","volume":"52","author":"Sigurdsson","year":"1950","journal-title":"Am. J. Hyg."},{"key":"ref_38","first-page":"40","article-title":"Myalgic encephalomyelitis: A baffling syndrome with a tragic aftermath","volume":"153","author":"Ramsay","year":"1981","journal-title":"ME Assoc. J."},{"key":"ref_39","unstructured":"Ramsay, A.M. (1986). Myalgic Encephalomyelitis and Postviral Fatigue States: The Saga of Royal Free Disease, Gower Medical Publishing."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"(1978). Epidemic myalgic encephalomyelitis. Br. Med. J., 1, 1436\u20131437.","DOI":"10.1136\/bmj.1.6125.1436-a"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1046\/j.1365-2796.1999.00513.x","article-title":"Chronic fatigue syndrome: New insights and old ignorance","volume":"246","author":"Evengard","year":"1999","journal-title":"J. Intern. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1177\/01632780122034993","article-title":"Assessing attitudes toward new names for chronic fatigue syndrome","volume":"24","author":"Jason","year":"2001","journal-title":"Eval. Health Prof."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1300\/J092v11n01_02","article-title":"Myalgic encephalomyelitis\/chronic fatigue syndrome: Clinical working case definition, diagnostic and treatment protocols","volume":"1","author":"Carruthers","year":"2003","journal-title":"J. Chronic Fatigue Syndr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/j.1365-2796.2011.02428.x","article-title":"Myalgic encephalomyelitis: International Consensus Criteria","volume":"270","author":"Carruthers","year":"2011","journal-title":"J. Intern. Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Chu, L., Valencia, I.J., Garvert, D.W., and Montoya, J.G. (2018). Deconstructing post-exertional malaise in myalgic encephalomyelitis\/chronic fatigue syndrome: A patient-centered, cross-sectional survey. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197811"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Chu, L., Valencia, I.J., Garvert, D.W., and Montoya, J.G. (2019). Onset patterns and course of myalgic encephalomyelitis\/chronic fatigue syndrome. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00012"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"953","DOI":"10.7326\/0003-4819-121-12-199412150-00009","article-title":"The chronic fatigue syndrome: A comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group","volume":"121","author":"Fukuda","year":"1994","journal-title":"Ann. Intern. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S0301-0511(01)00120-X","article-title":"Symptom occurrence in persons with chronic fatigue syndrome","volume":"59","author":"Jason","year":"2002","journal-title":"Biol. Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Stussman, B., Williams, A., Snow, J., Gavin, A., Scott, R., Nath, A., and Walitt, B. (2020). Characterization of post-exertional malaise in patients with myalgic encephalomyelitis\/chronic fatigue syndrome. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.01025"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1089\/jwh.2009.1507","article-title":"Postexertional malaise in women with chronic fatigue syndrome","volume":"19","author":"Stevens","year":"2010","journal-title":"J. Womens Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e060826","DOI":"10.1136\/bmjopen-2022-060826","article-title":"Long COVID and episodic disability: Advancing the conceptualisation, measurement and knowledge of episodic disability among people living with Long COVID\u2014Protocol for a mixed-methods study","volume":"12","author":"Brown","year":"2022","journal-title":"BMJ Open"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e011276","DOI":"10.1136\/bmjgh-2022-011276","article-title":"Conceptualising the episodic nature of disability among adults living with Long COVID: A qualitative study","volume":"8","author":"Brown","year":"2023","journal-title":"BMJ Glob. Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1177\/014107689108400224","article-title":"A report\u2013chronic fatigue syndrome: Guidelines for research","volume":"84","author":"Sharpe","year":"1991","journal-title":"J. R. Soc. Med."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Reeves, W.C., Wagner, D., Nisenbaum, R., Jones, J.F., Gurbaxani, B., Solomon, L., Papanicolaou, D.A., Unger, E.R., Vernon, S.D., and Heim, C. (2005). Chronic fatigue syndrome\u2014A clinically empirical approach to its definition and study. BMC Med., 3.","DOI":"10.1186\/1741-7015-3-19"},{"key":"ref_55","unstructured":"United States National Academy of Medicine (2015). Beyond Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: Redefining an Illness. The National Academies Collection: Reports Funded by National Institutes of Health, NAM."},{"key":"ref_56","unstructured":"National Institute for Health and Care Excellence (2021). Myalgic Encephalomyelitis (or Encephalopathy)\/Chronic Fatigue Syndrome: Diagnosis and Management\u2014NICE Guideline, No. 206, National Institute for Health and Care Excellence: Guidelines; National Institute for Health and Care Excellence."},{"key":"ref_57","unstructured":"(1956). A new clinical entity?. Lancet, 270, 789\u2013790."},{"key":"ref_58","unstructured":"World Health Organization (1969). Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death Based on the Recommendations of the Eighth Revision Conference, World Health Organization. [8th ed.]."},{"key":"ref_59","unstructured":"World Health Organization (2022). ICD-11: International Classification of Diseases, 11th revision, World Health Organization."},{"key":"ref_60","unstructured":"American Psychiatric Association (1952). Committee on Nomenclature and Statistics. Mental Disorders, Diagnostic and Statistical Manual; American Psychiatric Association."},{"key":"ref_61","unstructured":"American Psychiatric Association (1968). Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [2nd ed.]."},{"key":"ref_62","unstructured":"American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [3rd ed.]."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1192\/apt.12.2.152","article-title":"Conversion disorder: The modern hysteria","volume":"12","author":"Owens","year":"2006","journal-title":"Adv. Psychiatr. Treat."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR, American Psychiatric Association Publishing. [5th ed., text revision ed.].","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_66","unstructured":"Mayo Clinic (2023, October 12). Dissociative Disorders. Available online: https:\/\/www.mayoclinic.org\/diseases-conditions\/dissociative-disorders\/symptoms-causes\/syc-20355215."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1017\/S0033291719003386","article-title":"Reduced limbic microstructural integrity in functional neurological disorder","volume":"51","author":"Diez","year":"2021","journal-title":"Psychol. Med."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Hassa, T., Spiteri, S., Schmidt, R., Merkel, C., and Schoenfeld, M.A. (2021). Increased amygdala activity associated with cognitive reappraisal strategy in functional neurologic disorder. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.613156"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/B978-0-444-64196-0.00014-5","article-title":"The role of the anterior and midcingulate cortex in the neurobiology of functional neurologic disorder","volume":"166","author":"Ospina","year":"2019","journal-title":"Handb. Clin. Neurol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1002\/hbm.23853","article-title":"Cortical thickness alterations linked to somatoform and psychological dissociation in functional neurological disorders","volume":"39","author":"Perez","year":"2018","journal-title":"Hum. Brain Mapp."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1136\/jnnp-2017-316359","article-title":"Corticolimbic structural alterations linked to health status and trait anxiety in functional neurological disorder","volume":"88","author":"Perez","year":"2017","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.jpsychires.2018.04.006","article-title":"Individual differences in corticolimbic structural profiles linked to insecure attachment and coping styles in motor functional neurological disorders","volume":"102","author":"Williams","year":"2018","journal-title":"J. Psychiatr. Res."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Gutkin, M., McLean, L., Brown, R., and Kanaan, R.A. (2020). Systematic review of psychotherapy for adults with functional neurological disorder. J. Neurol. Neurosurg. Psychiatry, Online ahead of print.","DOI":"10.1136\/jnnp-2019-321926"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1176\/appi.ajp.2010.09101440","article-title":"Issues for DSM-5: Conversion disorder","volume":"167","author":"Stone","year":"2010","journal-title":"Am. J. Psychiatry"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1002\/wps.21151","article-title":"Functional neurological disorder: Defying dualism","volume":"23","author":"Stone","year":"2024","journal-title":"World Psychiatry"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1136\/jnnp-2022-330192","article-title":"Functional neurological disorder is a feminist issue","volume":"94","author":"McLoughlin","year":"2023","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"i2","DOI":"10.1136\/jnnp.2004.061655","article-title":"Functional symptoms and signs in neurology: Assessment and diagnosis","volume":"76","author":"Stone","year":"2005","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_78","unstructured":"National Institute for Health and Care Excellence (2023, October 12). Suspected Neurological Conditions: Recognition and Referral|NICE Guideline [NG127]. Available online: https:\/\/www.nice.org.uk\/guidance\/ng127."},{"key":"ref_79","unstructured":"ME Association (2023, October 12). ME Association Petition: M.E. is Not a Functional Disorder. 27 September 2017. Available online: https:\/\/meassociation.org.uk\/2017\/09\/me-association-petition-m-e-is-not-a-functional-disorder-27-september-2017\/."},{"key":"ref_80","unstructured":"Anonymous (2023, October 12). The On-Call Doctor Rejected Line\u2019s Desperate Call Just Days before Her Husband\u2019s Death: \u2018He Was Let Down by the System\u2019. Available online: https:\/\/www-bt-dk.translate.goog\/samfund\/vagtlaegen-afviste-lines-desperate-opkald-faa-dage-foer-sin-mands-doed-han-blev?_x_tr_sl=da&_x_tr_tl=en&_x_tr_hl=en-US&_x_tr_pto=wapp."},{"key":"ref_81","unstructured":"ME Action (2023, October 12). Advocacy Update from Finland. Available online: https:\/\/www.meaction.net\/2020\/12\/07\/advocacy-update-from-finland\/."},{"key":"ref_82","unstructured":"American Psychiatric Association (2022). Desk Reference to the Diagnostic Criteria from DSM-5-TR, American Psychiatric Association."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/NRL.0000000000000453","article-title":"Functional neurological disorders: Clinical spectrum, diagnosis, and treatment","volume":"27","author":"Mishra","year":"2022","journal-title":"Neurologist"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1007\/s11910-023-01320-z","article-title":"Autonomic manifestations of long-COVID syndrome","volume":"23","author":"Hira","year":"2023","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.tem.2023.03.002","article-title":"Long COVID: Pathophysiological factors and abnormalities of coagulation","volume":"34","author":"Turner","year":"2023","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1080\/17474086.2023.2288154","article-title":"Long-term hypercoagulability, endotheliopathy and inflammation following acute SARS-CoV-2 infection","volume":"16","author":"Boccatonda","year":"2023","journal-title":"Expert Rev. Hematol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s10456-021-09805-6","article-title":"COVID-19 is a systemic vascular hemopathy: Insight for mechanistic and clinical aspects","volume":"24","author":"Smadja","year":"2021","journal-title":"Angiogenesis"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1038\/s41590-023-01601-2","article-title":"SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC)","volume":"24","author":"Proal","year":"2023","journal-title":"Nat. Immunol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1038\/s41590-023-01724-6","article-title":"Long COVID manifests with T cell dysregulation, inflammation and an uncoordinated adaptive immune response to SARS-CoV-2","volume":"25","author":"Yin","year":"2024","journal-title":"Nat. Immunol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1002\/jnr.24917","article-title":"A role for T-cell exhaustion in Long COVID-19 and severe outcomes for several categories of COVID-19 patients","volume":"99","author":"Roe","year":"2021","journal-title":"J. Neurosci. Res."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1093\/infdis\/jiad131","article-title":"Reduced exercise capacity, chronotropic incompetence, and early systemic inflammation in cardiopulmonary phenotype long coronavirus disease 2019","volume":"228","author":"Durstenfeld","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"e2236057","DOI":"10.1001\/jamanetworkopen.2022.36057","article-title":"Use of cardiopulmonary exercise testing to evaluate long COVID-19 symptoms in adults: A systematic review and meta-analysis","volume":"5","author":"Durstenfeld","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1038\/s41420-021-00464-6","article-title":"Long COVID: An estrogen-associated autoimmune disease?","volume":"7","author":"Ortona","year":"2021","journal-title":"Cell Death Discov."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"103625","DOI":"10.1016\/j.transci.2022.103625","article-title":"Autoimmune complications of COVID-19 and potential consequences for long-lasting disease syndromes","volume":"62","author":"Amiral","year":"2023","journal-title":"Transfus. Apher. Sci."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Vojdani, A., Vojdani, E., Saidara, E., and Maes, M. (2023). Persistent SARS-CoV-2 Infection, EBV, HHV-6 and other factors may contribute to inflammation and autoimmunity in long COVID. Viruses, 15.","DOI":"10.3390\/v15020400"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"00714-2023","DOI":"10.1183\/23120541.00714-2023","article-title":"Differential cardiopulmonary haemodynamic phenotypes in PASC-related exercise intolerance","volume":"10","author":"Kahn","year":"2024","journal-title":"ERJ Open Res."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.chest.2021.08.010","article-title":"Persistent exertional intolerance after COVID-19: Insights from invasive cardiopulmonary exercise testing","volume":"161","author":"Singh","year":"2022","journal-title":"Chest"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/s41467-023-44432-3","article-title":"Muscle abnormalities worsen after post-exertional malaise in long COVID","volume":"15","author":"Appelman","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"e200244","DOI":"10.1212\/NXI.0000000000200244","article-title":"Case-control study of individuals with small fiber neuropathy after COVID-19","volume":"11","author":"McAlpine","year":"2024","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1053\/j.gastro.2022.09.024","article-title":"Human gut microbiota and its metabolites impact immune responses in COVID-19 and its complications","volume":"164","author":"Nagata","year":"2023","journal-title":"Gastroenterology"},{"key":"ref_101","unstructured":"United States Centers for Disease Control and Prevention (2023, July 10). New ICD-10-CM Code for Post-COVID Conditions, Following the 2019 Novel Coronavirus (COVID-19), Available online: https:\/\/www.cdc.gov\/nchs\/data\/icd\/announcement-new-icd-code-for-post-covid-condition-april-2022-final.pdf."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1002\/mdc3.13812","article-title":"Increased frequency of self-reported obsessive-compulsive symptoms in patients with functional movement disorders","volume":"10","author":"Novakova","year":"2023","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1080\/13546805.2023.2275336","article-title":"Cognitive profile in functional disorders","volume":"28","author":"Roivainen","year":"2023","journal-title":"Cogn. Neuropsychiatry"},{"key":"ref_104","first-page":"18","article-title":"Anxiety, depression and management of medically unexplained symptoms in medical clinics","volume":"30","author":"Hamilton","year":"1996","journal-title":"J. R. Coll. Physicians Lond."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/PSY.0000000000000010","article-title":"Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis","volume":"76","author":"Afari","year":"2014","journal-title":"Psychosom. Med."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1111\/ene.15721","article-title":"Functional neurological disorder in people with long COVID: A systematic review","volume":"30","author":"Teodoro","year":"2023","journal-title":"Eur. J. Neurol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"28","DOI":"10.7861\/clinmed.2020-0987","article-title":"A practical review of functional neurological disorder (FND) for the general physician","volume":"21","author":"Bennett","year":"2021","journal-title":"Clin. Med."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"e1146","DOI":"10.1212\/NXI.0000000000001146","article-title":"Peripheral neuropathy evaluations of patients with prolonged long COVID","volume":"9","author":"Oaklander","year":"2022","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1002\/mus.27379","article-title":"Non-length-dependent small fiber neuropathy: Not a matter of stockings and gloves","volume":"65","author":"Gemignani","year":"2022","journal-title":"Muscle Nerve"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Larsen, N.W., Stiles, L.E., Shaik, R., Schneider, L., Muppidi, S., Tsui, C.T., Geng, L.N., Bonilla, H., and Miglis, M.G. (2022). Characterization of autonomic symptom burden in long COVID: A global survey of 2314 adults. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.1012668"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s10286-020-00738-6","article-title":"Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness: Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN)","volume":"31","author":"Thijs","year":"2021","journal-title":"Clin. Auton. Res."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"S60","DOI":"10.1002\/nau.24233","article-title":"Psychological comorbidities and functional neurological disorders in women with idiopathic urinary retention: International Consultation on Incontinence Research Society (ICI-RS) 2019","volume":"39","author":"Panicker","year":"2020","journal-title":"Neurourol. Urodyn."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s10286-021-00803-8","article-title":"Autonomic dysfunction following COVID-19 infection: An early experience","volume":"31","author":"Shouman","year":"2021","journal-title":"Clin. Auton. Res."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S2215-0366(19)30405-5","article-title":"Functional cognitive disorders: A systematic review","volume":"7","author":"McWhirter","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"3484","DOI":"10.1016\/j.neuron.2022.10.006","article-title":"The neurobiology of long COVID","volume":"110","author":"Monje","year":"2022","journal-title":"Neuron"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"4193","DOI":"10.1093\/brain\/awac270","article-title":"COVID-19 induces CNS cytokine expression and loss of hippocampal neurogenesis","volume":"145","author":"Soung","year":"2022","journal-title":"Brain"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Voruz, P., Allali, G., Benzakour, L., Nuber-Champier, A., Thomasson, M., Jacot de Alc\u00e2ntara, I., Pierce, J., Lalive, P.H., L\u00f6vblad, K.-O., and Braillard, O. (2022). Long COVID neuropsychological deficits after severe, moderate, or mild infection. Clin. Transl. Neurosci., 6.","DOI":"10.3390\/ctn6020009"},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Blackmon, K., Day, G.S., Powers, H.R., Bosch, W., Prabhakaran, D., Woolston, D., and Pedraza, O. (2022). Neurocognitive screening in patients following SARS-CoV-2 infection: Tools for triage. BMC Neurol., 22.","DOI":"10.1186\/s12883-022-02817-9"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.genhosppsych.2022.07.013","article-title":"Screening for brain fog: Is the montreal cognitive assessment an effective screening tool for neurocognitive complaints post-COVID-19?","volume":"78","author":"Lynch","year":"2022","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1038\/s41586-023-06651-y","article-title":"Distinguishing features of long COVID identified through immune profiling","volume":"623","author":"Klein","year":"2023","journal-title":"Nature"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1038\/s41577-023-00904-7","article-title":"The immunology of long COVID","volume":"23","author":"Altmann","year":"2023","journal-title":"Nat. Rev. Immunol."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1038\/s41590-022-01380-2","article-title":"A patient-centric modeling framework captures recovery from SARS-CoV-2 infection","volume":"24","author":"Ruffieux","year":"2023","journal-title":"Nat. Immunol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"e200097","DOI":"10.1212\/NXI.0000000000200097","article-title":"Deep phenotyping of neurologic postacute sequelae of SARS-CoV-2 infection","volume":"10","author":"Mina","year":"2023","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1038\/s41586-022-04569-5","article-title":"SARS-CoV-2 is associated with changes in brain structure in UK Biobank","volume":"604","author":"Douaud","year":"2022","journal-title":"Nature"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"4256","DOI":"10.1038\/s41467-024-48651-0","article-title":"Cerebral microstructural alterations in Post-COVID-condition are related to cognitive impairment, olfactory dysfunction and fatigue","volume":"15","author":"Hosp","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"108647","DOI":"10.1016\/j.isci.2023.108647","article-title":"Glymphatic system dysfunction in recovered patients with mild COVID-19: A DTI-ALPS study","volume":"27","author":"Wu","year":"2024","journal-title":"iScience"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1038\/s41593-024-01576-9","article-title":"Blood-brain barrier disruption and sustained systemic inflammation in individuals with long COVID-associated cognitive impairment","volume":"27","author":"Greene","year":"2024","journal-title":"Nat. Neurosci."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Chaganti, J., Poudel, G., Cysique, L.A., Dore, G.J., Kelleher, A., Matthews, G., Darley, D., Byrne, A., Jakabek, D., and Zhang, X. (2024). Blood brain barrier disruption and glutamatergic excitotoxicity in post-acute sequelae of SARS COV-2 infection cognitive impairment: Potential biomarkers and a window into pathogenesis. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1350848"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.bbi.2024.04.015","article-title":"Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by [(11)C]PBR28 PET correlates with vascular disease measures","volume":"119","author":"VanElzakker","year":"2024","journal-title":"Brain Behav. Immun."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"eadk3295","DOI":"10.1126\/scitranslmed.adk3295","article-title":"Tissue-based T cell activation and viral RNA persist for up to 2 years after SARS-CoV-2 infection","volume":"16","author":"Peluso","year":"2024","journal-title":"Sci. Transl. Med."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"102623","DOI":"10.1016\/j.nicl.2021.102623","article-title":"Neuroimaging in functional neurological disorder: State of the field and research agenda","volume":"30","author":"Perez","year":"2021","journal-title":"Neuroimage Clin."},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"Mavroudis, I., Kazis, D., Kamal, F.Z., Gurzu, I.L., Ciobica, A., Padurariu, M., Novac, B., and Iordache, A. (2024). Understanding Functional Neurological Disorder: Recent insights and diagnostic challenges. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25084470"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"103625","DOI":"10.1016\/j.nicl.2024.103625","article-title":"BOLD signal variability as potential new biomarker of functional neurological disorders","volume":"43","author":"Schneider","year":"2024","journal-title":"Neuroimage Clin."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"e1870","DOI":"10.1212\/WNL.0000000000006514","article-title":"Gray matter differences in patients with functional movement disorders","volume":"91","author":"Maurer","year":"2018","journal-title":"Neurology"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"101798","DOI":"10.1016\/j.nicl.2019.101798","article-title":"Structural alterations in functional neurological disorder and related conditions: A software and hardware problem?","volume":"22","author":"Begue","year":"2019","journal-title":"Neuroimage Clin."},{"key":"ref_136","doi-asserted-by":"crossref","unstructured":"van Campen, C., Rowe, P.C., Verheugt, F.W.A., and Visser, F.C. (2020). Cognitive function declines following orthostatic stress in adults with myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS). Front. Neurosci., 14.","DOI":"10.3389\/fnins.2020.00688"},{"key":"ref_137","doi-asserted-by":"crossref","unstructured":"van Campen, C., Rowe, P.C., Verheugt, F.W.A., and Visser, F.C. (2020). Numeric rating scales show prolonged post-exertional symptoms after orthostatic testing of adults with myalgic encephalomyelitis\/chronic fatigue syndrome. Front. Med., 7.","DOI":"10.3389\/fmed.2020.602894"},{"key":"ref_138","doi-asserted-by":"crossref","unstructured":"van Campen, C., Rowe, P.C., and Visser, F.C. (2020). Cerebral blood flow is reduced in severe myalgic encephalomyelitis\/chronic fatigue syndrome patients during mild orthostatic stress testing: An exploratory study at 20 degrees of head-up tilt testing. Healthcare, 8.","DOI":"10.3390\/healthcare8020169"},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.cnp.2021.09.001","article-title":"Cerebral blood flow remains reduced after tilt testing in myalgic encephalomyelitis\/chronic fatigue syndrome patients","volume":"6","author":"Rowe","year":"2021","journal-title":"Clin. Neurophysiol. Pract."},{"key":"ref_140","doi-asserted-by":"crossref","unstructured":"van Campen, C.M.C., Rowe, P.C., and Visser, F.C. (2023). Worsening symptoms is associated with larger cerebral blood flow abnormalities during tilt-testing in myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS). Medicina, 59.","DOI":"10.3390\/medicina59122153"},{"key":"ref_141","doi-asserted-by":"crossref","unstructured":"Blitshteyn, S., and Verduzco-Gutierrez, M. (2024). Long COVID: A major public health issue. Am. J. Phys. Med. Rehabil., Online ahead of print.","DOI":"10.1097\/PHM.0000000000002486"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/8\/799\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:25:36Z","timestamp":1760109936000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/8\/799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,29]]},"references-count":141,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jpm14080799"],"URL":"https:\/\/doi.org\/10.3390\/jpm14080799","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,29]]}}}