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Imaging study finds brain structural changes linked to physical, mental health in functional neurological disorder

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An imaging study by Massachusetts General Hospital (MGH) investigators has identified differences in key brain structures of individuals whose physical or mental health has been most seriously impaired by a common but poorly understood condition called functional neurological disorder (FND). In their report published online in the Journal of Neurology, Neurosurgery and Psychiatry, the research team describes reductions in the size of a portion of the insula in FND patients with the most severe physical symptoms and relative volume increases in the amygdala among those most affected by mental health symptoms.

“The brain regions implicated in this structural neuroimaging study are areas involved in the integration of emotion processing, sensory-motor and cognitive functions, which may help us understand why patients with functional neurological disorder exhibit such a mix of symptoms,” says David Perez, MD, MMSc, of the MGH Departments of Neurology and Psychiatry, lead and corresponding author of the report. “While this is a treatable condition, many patients remain symptomatic for years, and the prognosis varies from patient to patient. Advancing our understanding the pathophysiology of FND is the first step in beginning to develop better treatments.”

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One of the most common conditions bringing patients to neurologists, FND involves a constellation of neurologic symptoms – including weakness, tremors, walking difficulties, convulsions, pain and fatigue – not explained by traditional neurologic diagnoses. This condition has also been called conversion disorder, reflecting one theory that patients were converting emotional distress into physical symptoms, but Perez notes that this now appears to be an oversimplified view of a complex neuropsychiatric condition. The research team hopes that advancing the neurobiological understanding of FND will increase awareness and decrease the stigma – including skepticism about the reality of patients’ symptoms – often associated with this condition.

Previous functional MRI studies have suggested that a group of brain structures forming part of what is called the salience network – which are involved in detecting important bodily and environmental stimuli, as well as integrating emotional, cognitive and sensory-motor experiences – showed increased activity in FND patients during a variety of behavioral and emotion-processing tasks. The current study is one of the first to examine structural relationships between components of the salience network and the physical and mental health of patients with FND.
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