Real-time antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

Remote monitoring technologies (RMT) could provide critical insights into the mechanisms underlying functional neurological symptoms (FNS). We examined the feasibility and acceptability of a novel RMT protocol, aiming to identify psychobiological correlates and antecedents of FNS in everyday life. Seventeen individuals with FNS (seizures/motor) and 17 healthy controls (HC) completed ecological momentary assessments (EMA) eight times daily for 1-week, reporting FNS severity, associated physical and psychological symptoms, and subjectively significant events. Sleep quality was reported daily. Fitbit Charge 5s measured objective physiological variables. Multilevel modelling examined variables associated with FNS variability. EMA completion rates were high (≥80%). At week-level, the FNS group reported significantly elevated subjective arousal, pain, fatigue, dissociation, negative affect, daily events, stressful events, and sleep duration, compared to HC. Objective sleep disturbance and duration, and resting heartrate, were also significantly greater in the FNS sample. FNS severity correlated significantly with daily events, affect, subjective arousal, pain, fatigue and sleep disturbance, at day- or within-day levels. Daily events and negative affect temporally predicted momentary FNS severity. RMTs are feasible and acceptable tools for investigation of FNS in real-world settings, revealing daily events and negative affect as possible triggers of FNS. Larger-scale, longer-term RMT studies are needed in FND.