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Precision dynamics of predictive coding in functional neurological disorder.

Stanley Lyndon1,2,3

  • 1Harvard Medical School, Boston, MA 02115, USA.

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Summary
This summary is machine-generated.

Functional neurological disorder (FND) involves genuine symptoms from altered brain regulation, not tissue damage. This new model explains FND as a precision control issue, aiding diagnosis and treatment.

Keywords:
active inferenceautonomic arousaldynamic precision controlfunctional neurological disorderloss of agencypredictive coding

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Neurology

Background:

  • Functional neurological disorder (FND) presents complex, disabling symptoms with preserved structural integrity, challenging diagnosis and patient understanding.
  • FND symptoms are real, stemming from altered brain regulation rather than conscious control or tissue damage.

Purpose of the Study:

  • To offer a clinically applicable framework for understanding Functional Neurological Disorder (FND) by reframing it as a disorder of precision control within predictive coding.
  • To explain the mechanisms behind FND symptoms and guide diagnostic and therapeutic strategies.

Main Methods:

  • Modeling brain's predictive coding precision as a dynamic quantity influenced by arousal and recalibration.
  • Utilizing a four-level hierarchical model (affective, interoceptive, proprioceptive, spinal) to illustrate symptom generation.
  • Analyzing how arousal impacts prediction weighting and feedback suppression to produce FND symptoms.

Main Results:

  • Arousal can temporarily cause maladaptive predictions to dominate, suppressing corrective feedback and leading to diverse FND symptoms.
  • The model explains characteristic FND signs like distractibility, entrainment, and give-way weakness.
  • The framework clarifies the subjective experience of reduced agency in FND without implying malingering.

Conclusions:

  • The predictive coding precision framework offers an intuitive model for explaining FND symptoms to patients.
  • It provides a rationale for therapies like physiotherapy, psychotherapy, and mindfulness/biofeedback by targeting arousal and precision recalibration.
  • This approach unifies diagnosis, communication, and treatment planning, establishing a foundation for precision-guided care in FND.