Imaging study provides insights on functional neurological disorder

Imaging study provides insights on functional neurological disorder

Individuals with functional neurological disorder (FND) have symptoms not explained by traditional neurological conditions.

New research led by investigators at Massachusetts General Hospital (MGH) and published in Psychological Medicine has uncovered pathways in the brain’s white matter that may be altered in patients with functional neurological disorder (FND).

Symptoms associated with functional neurological disorder (FND) can including limb weakness, tremor, gait abnormalities, seizures and sensory deficits.

The new findings advance current understanding of the mechanisms involved in this disease, and offer the possibility of identifying markers of the condition and patients’ prognosis.

Magnetic resonance imaging

Because conventional tests such as clinical magnetic resonance imaging (MRI) brain scans and electroencephalograms (EEGs) are usually normal in patients with functional neurological disorder, there are currently no brain-based markers for this disorder and diagnoses are made using physical examination signs.

More precise research-based imaging methods such as functional MRI and quantitative MRI have revealed several differences in the brains of some patients, including in grey matter regions. To look for any differences in the brain’s white matter — which is composed of bundles of axons coated with protective myelin to help conduct nerve signals — investigators used a technique called diffusion tensor imaging (DTI), which measures the diffusion of water molecules.

The team used DTI to examine the brain white matter of 32 patients with FND and 36 healthy controls. Patients also provided information on the severity of their symptoms, the extent of the physical disability they experience, and the duration of their illness.

The researchers found that patient-reported impairments in physical health and illness duration were each associated with disruptions in white matter fibres within the stria terminalis/fornix, a pathway that is the principal output of the amygdala and hippocampus (brain areas that play roles in emotion/salience and learning/memory, respectively).

This is notable given that several structural and functional neuroimaging studies have identified amygdalar and hippocampal abnormalities in patients with FND. Furthermore, reduced integrity within another pathway called the medial forebrain bundle also showed a relationship to patient-reported physical health impairments.

Importance of white matter pathways

Lead author Ibai Diez, PhD, a senior research fellow in Neurology at MGH, said: “The findings point to the potential importance of white matter pathways in the biology of FND.

“Our methodological approach here is another novelty. We conducted a set of network analyses that not only identifies patterns of white matter alterations, but also links specific patterns of white matter changes to cortical and subcortical brain areas.”

Additional research is needed to determine the potential clinical relevance of the results.

Senior author David Perez, MD, MMSc director of the MGH FND Clinical and Research Programs, said: “Given that white matter disruptions in the stria terminalis/fornix and medial forebrain bundle related to patient-reported impairments in physical health and illness duration, future analyses should evaluate if these white matter profiles might be connected to specific clinical outcomes.

“Our work also requires further clarification and replication in large sample future studies.”

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  1. This might give us a clue as to the etiology of other Chronic functional neurological disorders like fibromyalgia, chronic fatigue syndrome, post Borellia syndrome, etc. Hasan Moolla. 28 November 2019.

    • I really need help any one out here im being under diagnosed telling me every thing is find an i know im dealing with nuro toxic brain damage an some one not telling the truth please help me 2168351455 ….

    • My son has FND. This is the firat time I have read about any kind of study. So much more research needs done. My son loses his ability to walk. He also loses
      the ability to use his arms. He is 17 and devoped this after falling down. Its crazy how he has been affected by this. Please do more research.

      • I have suffered for years after becoming very ill in Gambia leaving me paralysed for months. Having seizures. I was in a wheelchair now on crutches. If i get distracted i fall over which is often. I tire easily, i have meniers, double vision, deaf in one ear. Body tremours raynards in hands and feet suffer with the cold and chronic fatigue syndrome. Speach problems when tired Under specialist for FND . Have done all the cbt and councelling physio, so now they just say have some antidepressants.

  2. I am currently diagnosed Mild degree cerebral atrophy with minimal periventeicular and deep white matter small vessel chronic ischemic demyelinating changes plz help me

  3. A few months ago i had brain scan, mri, with ,with dye. When they did the dye ,it burned so bad, i screamed .i actually thought i saw blazes of fire in my head. Any other times i had contrast, it just felt warm. What would make this feel like fire. My head still hurts in that same area, every now and again. They told me it happens sometimes, but no answer. Please tell me why. Thank you.

  4. I need help i was being overdose by metformin pills an i know i have Neuro toxic an being under diagnosed headaches are killing an its said i caint get the help i need.any suggestions for a mal practice cover up hospitals taking up for hospital i don’t wanna die screaming help please metro hospital overdose me university hospitals an cleveland clinic taking up for them 4000 mg pill of metformin is way to much for the body an they said im a disease state for diabetic an didnt catch i was taking an over dose on metformin with other pill for 23 months..crying for help an im a mental health patient. That no lawyer wanted to take my case cause the doc that over dose me her husband is a well known lawyer an they had my name up in air to let every lawyer know dont take my case help any one

    • Ella, I hope you come back here to see this reply at some point in the future. Go online to Diabetes UK . They have a Low Carb forum within there (bit like Keto) where so many people have been taken off Metformin as they have ‘reversed’ their Diabetes. I don’t know if you are type 11 or type 1 but even type 1 have managed it (with careful planning). You can find all this out on there. I don’t think you have to be in UK to read it or join it. Also look up Doctor David Unwin and Diabetes and Dr. Eric Berg

  5. Thank you for this article
    My wife was diagnosed with fnd in November 2019 after 18 months of suffering
    She was a fit healthy 52 year old then our lives changed completely and although we now have learned to cope it’s been difficult especially getting real help
    I’m glad that maybe this study may lead to greater understanding and treatment one day soon

  6. Hello team ,

    My sister has FND , I went to a consultant Q&A .and there were many people also who had support self help , physio/ occupational health support etc,
    But I noticed that at no point had anyone looks at the food they were eating couple with exercise?
    Has there been any study’s on cases with such like recovery programs in place ?

    There also seemed to be a lot of variations of NFD ?

    At this point I’m trying to get a better handle on it ?

    Does it also cause uncharacteristic aggression and ranting ?

    Many thanks in advance!


  7. Where can I find functional neurologist in Germany or Austria Please? My doughter suffers from seizures and MRI and EEg are normal all the time, No diseases, trauma or injuries as previous condition only hormonal disbalance, high level of Prolactin- micro adenoma and DHEAs hormone, plus leaky gut! Thank you very much, Please help!


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