A framework for understanding the pathophysiology of functional neurological disorder

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Psychology

Background:

• Functional Neurological Disorder (FND) symptoms are intrinsically linked to its underlying pathophysiology.
• Understanding FND requires examining dysfunctions across various brain circuits and their impact on cognitive and emotional processes.

Purpose of the Study:

• To review key constructs affected in FND, including emotion processing, agency, attention, interoception, and predictive processing.
• To highlight the role of neural circuits such as salience, multimodal integration, and attention networks in FND.
• To propose a research agenda focused on the pathophysiology of FND to guide future research and funding.

Main Methods:

• Perspective article format, synthesizing current knowledge on FND pathophysiology.
• Review of five affected constructs: emotion processing, agency, attention, interoception, and predictive processing/inference.
• Identification of relevant neural circuits implicated in FND, including salience, multimodal integration, and attention networks.

Main Results:

• FND symptoms result from complex interactions within and across multiple brain circuits.
• Specific constructs like emotion processing, agency, attention, interoception, and predictive processing are consistently affected in FND.
• Patient symptoms can be characterized by the interplay of dysfunctions in these networks and processes.

Conclusions:

• A deeper understanding of FND pathophysiology is essential for clinical advancement.
• Further investigation is needed to elucidate how biopsychosocial factors contribute to pathophysiological abnormalities in FND.
• A pathophysiology-focused research agenda is proposed to stimulate progress in this under-resourced field.