Structural alterations in functional neurological disorder and related conditions: A software and hardware problem?

Bègue, Indrit; Adams, Caitlin; Stone, Jon; Perez, David L.

doi:10.1016/j.nicl.2019.101798

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Title		Structural alterations in functional neurological disorder and related conditions: A software and hardware problem?
Authors		Bègue, Indrit Adams, Caitlin Stone, Jon Perez, David L.
Published in		NeuroImage: Clinical. 2019, vol. 22, p. 101798
Abstract		Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A “software” vs. “hardware” analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including “disease staging” discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a “software” and “hardware” problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder.
Keywords		Conversion disorder — Psychogenic — Neuroimaging — MRI — Functional neurological disorder — Somatic symptom disorder
Identifiers		DOI: 10.1016/j.nicl.2019.101798 PMID: 31146322
Full text		Article (Published version) (1.1 MB) - Free access Other version: https://linkinghub.elsevier.com/retrieve/pii/S2213158219301482
Structures		Faculté de médecine / Section de médecine clinique / Département de psychiatrie Faculté de médecine / Section de médecine fondamentale / Département de neurosciences fondamentales
Research group		Mécanismes cérébraux du comportement et des fonctions cognitives (701)
Citation (ISO format)		BÈGUE, Indrit et al. Structural alterations in functional neurological disorder and related conditions: A software and hardware problem?. In: NeuroImage: Clinical, 2019, vol. 22, p. 101798. doi: 10.1016/j.nicl.2019.101798 https://archive-ouverte.unige.ch/unige:126076