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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, United States.

Frontiers in Psychiatry

|March 10, 2025

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 in brain regions crucial for body awareness and homeostatic inference in FMD patients.

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, but findings are inconsistent.
Functional movement disorder (FMD) involves abnormal processing of internal body sensations.

Purpose of the Study:

To investigate neural correlates of interoceptive attention in functional movement disorder (FMD) using functional magnetic resonance imaging (fMRI).
To examine differences in brain activity and self-reported interoception between individuals with FMD and healthy controls.

Main Methods:

Voxelwise fMRI analyses compared blood oxygenation level-dependent responses between 13 adults with hyperkinetic FMD and 13 healthy controls.
Participants performed a task involving attention to bodily sensations (heartbeat, stomach, body) and an exteroceptive stimulus.
Self-reported interoception measures were assessed and correlated with neural activity.

Main Results:

Interoceptive tasks activated a network including the precuneus, posterior cingulate cortex (PCC), caudate nucleus (CN), and right anterior insula (aINS) in both groups.
Group differences emerged in processing disease-related interoceptive signals, with FMD patients showing broader activation than controls for 'body' sensations.
Specific differences in brain activity between FMD and controls were observed in PCC, CN, angular gyrus, thalamus, and mid-insula during different interoceptive focuses.

Conclusions:

This study provides novel evidence linking FMD to abnormal interoceptive processing in key brain regions.
Findings highlight alterations in monitoring body state, attentional focus, and homeostatic inference in FMD.
Abnormal interoceptive processing may contribute to the pathophysiology of functional movement disorder.