Functional Neurologic Disorder, La Lésion Dynamique: 2024 Wartenberg Lecture.

Area of Science:

• Neurology
• Neuroscience
• Psychiatry

Background:

• Functional neurologic disorders (FND) are a significant cause of disability.
• Historically termed "hysteria," their underlying mechanisms remain unclear.
• Jean-Martin Charcot proposed a "dynamic lesion" (la lésion dynamique) as a cause.

Discussion:

• FND is increasingly viewed through a multifactorial biopsychosocial lens, incorporating genetic predispositions.
• Early life trauma can lead to amygdala developmental abnormalities, predisposing individuals to FND.
• Stress-induced amygdala hyperactivity triggers limbic system activation, resulting in widespread brain network dysfunction.

Key Insights:

• "La lésion dynamique" is identified as specific brain network dysfunction, providing a clear pathological basis for FND.
• This network dysfunction is as real and significant as other neurological pathologies.
• Improved understanding of "la lésion dynamique" facilitates progress in FND patient care.

Outlook:

• Further research into brain network dysfunction in FND is expected to yield novel therapeutic strategies.
• Integrating biopsychosocial factors offers a comprehensive approach to managing FND.
• Recognizing network dysfunction as a core pathology will advance FND diagnosis and treatment.