Functional Connectivity Predictors and Mechanisms of Symptom Change in Functional Neurological Disorder
Christiana Westlin1,2,3,4, Cristina Bleier1,4, Andrew J Guthrie1,4
1Functional Neurological Disorder Unit and Research Group, Mass General Brigham, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA.
Medrxiv : the Preprint Server for Health Sciences
|February 6, 2026
Summary
Functional neurological disorder (FND) symptom changes are linked to brain network connectivity. Improved FND symptoms correlate with altered functional connectivity, particularly in the right anterior insula, offering insights into disorder mechanisms.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Imaging
Background:
- Functional neurological disorder (FND) presents variable clinical trajectories.
- Mechanisms driving FND heterogeneity are not well understood.
Purpose of the Study:
- To investigate resting-state functional connectivity predictors of symptom change in FND.
- To explore the mechanisms underlying symptom heterogeneity in FND.
Main Methods:
- Longitudinal study of 32 adults with FND undergoing naturalistic treatment.
- Functional MRI (fMRI) and graph theory metrics (centrality, integration, segregation) assessed at baseline and follow-up.
- Analyses adjusted for covariates and compared with healthy controls (HCs).
Main Results:
- 59.4% of patients showed improvement, with variable symptom trajectories.
- Greater FND symptom improvement linked to higher baseline between-network integration and reduced longitudinal within-network integration.
- Right anterior insula integration identified as a prognostic marker; increased within-network segregation in dorsal attention networks correlated with non-core symptom improvement.
Conclusions:
- Large-scale network interactions are potential prognostic indicators in FND.
- Brain network reorganization is mechanistically relevant to symptom change in FND.
Keywords:
clinical outcomesfMRIfunctional connectivityfunctional movement disorderfunctional seizuresgraph theoryMore Related Videos
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