A framework for understanding the pathophysiology of functional neurological disorder

The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs t...

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Published in:	CNS spectrums Vol. 26; no. 6; pp. 555 - 561
Main Authors:	Drane, Daniel L., Fani, Negar, Hallett, Mark, Khalsa, Sahib S., Perez, David L., Roberts, Nicole A.
Format:	Journal Article
Language:	English
Published:	New York, USA Cambridge University Press 01.12.2021
Subjects:	Brain research Emotions Feedback Medical imaging Movement disorders Neuroimaging Neurological disorders Neurosciences Pathophysiology Perspective Physiology Tremor (Muscular contraction) attention psychogenic emotion interoception agency conversion disorder
ISSN:	1092-8529, 2165-6509
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Abstract	The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs that are affected in FND: emotion processing (including salience), agency, attention, interoception, and predictive processing/inference. Examples of underlying neural circuits include salience, multimodal integration, and attention networks. The symptoms of each patient can be described as a combination of dysfunction in several of these networks and related processes. While we have gained a considerable understanding of FND, there is more work to be done, including determining how pathophysiological abnormalities arise as a consequence of etiologic biopsychosocial factors. To facilitate advances in this underserved and important area, we propose a pathophysiology-focused research agenda to engage government-sponsored funding agencies and foundations.
AbstractList	The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs that are affected in FND: emotion processing (including salience), agency, attention, interoception, and predictive processing/inference. Examples of underlying neural circuits include salience, multimodal integration, and attention networks. The symptoms of each patient can be described as a combination of dysfunction in several of these networks and related processes. While we have gained a considerable understanding of FND, there is more work to be done, including determining how pathophysiological abnormalities arise as a consequence of etiologic biopsychosocial factors. To facilitate advances in this underserved and important area, we propose a pathophysiology-focused research agenda to engage government-sponsored funding agencies and foundations. The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs that are affected in FND: emotion processing (including salience), agency, attention, interoception, and predictive processing/inference. Examples of underlying neural circuits include salience, multimodal integration, and attention networks. The symptoms of each patient can be described as a combination of dysfunction in several of these networks and related processes. While we have gained a considerable understanding of FND, there is more work to be done, including determining how pathophysiological abnormalities arise as a consequence of etiologic biopsychosocial factors. To facilitate advances in this underserved and important area, we propose a pathophysiology-focused research agenda to engage government-sponsored funding agencies and foundations.The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs that are affected in FND: emotion processing (including salience), agency, attention, interoception, and predictive processing/inference. Examples of underlying neural circuits include salience, multimodal integration, and attention networks. The symptoms of each patient can be described as a combination of dysfunction in several of these networks and related processes. While we have gained a considerable understanding of FND, there is more work to be done, including determining how pathophysiological abnormalities arise as a consequence of etiologic biopsychosocial factors. To facilitate advances in this underserved and important area, we propose a pathophysiology-focused research agenda to engage government-sponsored funding agencies and foundations. The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs that are affected in FND: emotion processing (including salience), agency, attention, interoception, and predictive processing/inference. Examples of underlying neural circuits include salience, multimodal integration, and attention networks. The symptoms of each patient can be described as a combination of dysfunction in several of these networks and related processes. While we have gained a considerable understanding of FND, there is more work to be done, including determining how pathophysiological abnormalities arise as a consequence of etiologic biopsychosocial factors of FND. To facilitate advances in this underserved and important area, we propose a pathophysiology-focused research agenda to engage government-sponsored funding agencies and foundations.
Author	Fani, Negar Hallett, Mark Drane, Daniel L. Perez, David L. Roberts, Nicole A. Khalsa, Sahib S.
AuthorAffiliation	1. Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA 4. Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA 6. School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA 3. Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA 5. Cognitive Behavioral Neurology and Neuropsychiatry Units, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 2. Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA
AuthorAffiliation_xml	– name: 4. Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA – name: 5. Cognitive Behavioral Neurology and Neuropsychiatry Units, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA – name: 6. School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA – name: 3. Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA – name: 1. Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA – name: 2. Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA
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Snippet	The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and...
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SubjectTerms	Brain research Emotions Feedback Medical imaging Movement disorders Neuroimaging Neurological disorders Neurosciences Pathophysiology Perspective Physiology Tremor (Muscular contraction)
Title	A framework for understanding the pathophysiology of functional neurological disorder
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