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Mega-analysis of Structural Brain Imaging in Functional Neurological Disorder
Matt Butler1, Miriam Vignando1, Jane B Allendorfer2
1Institute of Psychiatry, Psychology & Neuroscience, King's College London.
Biological Psychiatry
|July 10, 2026
Summary
This large study found subtle brain structural differences in functional neurological disorder (FND) patients, particularly in frontal and motor regions. These findings may indicate underlying vulnerabilities or compensatory changes in FND.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Imaging
Background:
- The pathophysiology of functional neurological disorder (FND) is not fully understood.
- Previous structural neuroimaging studies show inconsistent findings regarding grey matter alterations in FND.
- Mega-analyses can clarify structural alterations by combining data from multiple studies.
Purpose of the Study:
- To conduct a large-scale mega-analysis of brain structural morphometrics in FND.
- To identify consistent structural alterations in FND patients compared to healthy controls.
Main Methods:
- A mega-analysis of T1-weighted MRI scans from fifteen international research groups.
- Harmonization of data using ComBat.
- Comparison of 493 FND patients (motor and seizure variants) with 564 healthy controls.
- Inclusion of Euler numbers to control for head motion.
Main Results:
- Reduced cortical thickness in bilateral superior frontal gyri and sulci, superior precentral sulcus, right precentral gyrus, right paracentral gyrus and sulcus, right cuneus, and right inferior opercular gyrus.
- Reduced left postcentral gyrus surface area and right hippocampal volume.
- No associations found between morphometrics and illness duration, or history of depression/anxiety.
- No significant differences identified between motor and seizure variants of FND.
Conclusions:
- This mega-analysis reveals subtle morphometric differences in FND, predominantly in prefrontal and motor areas.
- These alterations may suggest predisposing vulnerabilities, compensatory mechanisms, or FND-specific changes.
- Further neuropsychiatric characterization of FND cohorts is needed to understand the biological relevance of these structural findings.
