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Functional Movement Disorder Is Associated with Abnormal Interoceptive Brain Activity: A Task-based Functional MRI

Primavera A Spagnolo^1,2,3, Jacob A Parker⁴, Mark Hallett⁵

¹Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA.

Medrxiv : the Preprint Server for Health Sciences

|August 7, 2024

Summary

This summary is machine-generated.

Functional movement disorder (FMD) is linked to altered brain activity during interoceptive attention, particularly when focusing on disease-related bodily sensations. This suggests abnormal processing of internal body states in FMD.

Keywords:

Default Mode Network Functional Movement Disorder Insula Interoception Prediction Error

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Area of Science:

Neuroscience
Psychiatry
Medical Imaging

Background:

Aberrant interoceptive processing is a proposed mechanism in functional neurological disorder (FND) pathophysiology.
Previous findings on interoception in FND have been inconsistent.
Functional movement disorder (FMD) is a subtype of FND.

Purpose of the Study:

To investigate neural correlates of interoceptive attention in adults with hyperkinetic FMD.
To compare brain activity during interoceptive and exteroceptive tasks between FMD patients and healthy controls (HCs).
To examine self-reported interoception and its relationship with neural activity in FMD.

Main Methods:

Functional magnetic resonance imaging (fMRI) was used to measure blood oxygenation level-dependent (BOLD) responses.
Voxelwise analyses compared brain activity between 13 adults with hyperkinetic FMD and 13 HCs.
Participants performed tasks focusing on bodily sensations (heartbeat, stomach, disease-related 'body') and an exteroceptive stimulus.

Main Results:

Interoceptive tasks activated a network including the precuneus, posterior cingulate cortex (PCC), caudate nucleus (CN), and right anterior insula (aINS).
Group differences were primarily observed in processing disease-related interoceptive signals, with broader activation in FMD.
Specific differences in brain activity related to interoceptive focus (body vs. heartbeat/stomach) were found in PCC, CN, angular gyrus, thalamus, and mid-insula.

Conclusions:

This study provides novel evidence linking FMD to abnormal interoceptive processing.
Abnormalities were identified in brain regions crucial for monitoring body state, attention, and homeostatic inference.
Findings suggest a neural basis for altered interoception in the pathophysiology of FMD.