Altered resting-state neural networks in children and adolescents with functional neurological disorder
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OBJECTIVES: Previous studies with adults suggest that aberrant communication between neural networks underpins functional neurological disorder (FND). The current study adopts a data-driven approach to investigate the extent that functional resting-state networks are disrupted in a pediatric mixed-FND cohort. METHODS: 31 children with mixed FND and 33 age- and sex-matched healthy controls completed resting-state fMRI scans. Whole-brain independent component analysis (pFWE < 0.05) was then used to identify group differences in resting-state connectivity. Self-report measures included the Depression, Anxiety and Stress Scale (DASS-21) and Early Life Stress Questionnaire (ELSQ). Resting-state heart rate (HR) and cortisol-awakening response (CAR) were available in a subset. RESULTS: Children with FND showed wide-ranging connectivity changes in eight independent components corresponding to eight resting-state neural networks: language networks (IC6 and IC1), visual network, frontoparietal network, salience network, dorsal attention network, cerebellar network, and sensorimotor network. Children whose clinical presentation included functional seizures (vs children with other FND symptoms) showed greater connectivity decreases in the frontoparietal and dorsal attentional networks. Subjective distress (total DASS score), autonomic arousal (indexed by HR), and HPA dysregulation (attenuated/reversed CAR) contributed to changes in neural network connectivity. Children with FND (vs controls) reported more subjective distress (total DASS score) and more adverse childhood experiences (ACEs) across their lifespan. CONCLUSIONS: Children with FND demonstrate changes in resting-state connectivity. Identified network alterations underpin a broad range of functions typically disrupted in children with FND. This study complements the adult literature by suggesting that FND in children and adolescents emerges in the context of their lived experience and that it reflects aberrant communication across neural networks.
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A child's expectations are reflected in her body, thoughts, and feelings and can potentially affect the course of her symptoms through mind-brain-body pathways.
“The child’s expectations will thus be reflected in her body, thoughts, and feelings and can potentially, through a range of mind–brain–body pathways, affect the course of her symptoms [24,25,27,38,39].”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [39]
The Discussion (page unavailable) describes brain-network processes that regulate bodily feelings and thoughts and could contribute to pain and fatigue symptoms in children with functional neurological disorder. It does not examine children’s expectations or show that expectations affect the course of symptoms. (LLM, conf=0.79)
Experimental — accuracy not yet measuredBoth the actual experience of social rejection and subsequent rejection-related thoughts and feelings function to activate neural networks that mediate the subjective experience of pain (>2/3 of the current cohort) and stress-system activation (autonomic system component), both of which are known to modulate aberrant neural network function in paediatric FND.
“Both the actual experience of social rejection and subsequent rejection-related thoughts and feelings function to activate neural networks that mediate the subjective experience of pain (>2/3 of the current cohort) [110,111,112] and stress-system activation (autonomic system component) [25], both of which are known to modulate aberrant neural network function in paediatric FND [39,113].”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [39]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredBecause subjective distress-which is driven and amplified by illness-promoting psychological processes-contributes to stress-system/neural network dysregulation that maintains FND symptoms, the psychological component of the treatment intervention is central to the therapeutic process.
“Moreover, because subjective distress—which is driven and amplified by illness-promoting psychological processes—contributes to stress-system/neural network dysregulation that maintains FND symptoms [38,39], the psychological component of the treatment intervention is central to the therapeutic process.”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [39]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThis cumulative stress was associated with dysregulation of the stress system and neural networks, high levels of subjective distress, and activation of psychological processes that typically arise when children's coping capacities-body and mind-have been dysregulated or overwhelmed.
“This cumulative stress was associated with dysregulation of the stress system and neural networks [38,39], high levels of subjective distress, and activation of psychological processes that typically arise when children’s coping capacities—body and mind—have been dysregulated or overwhelmed.”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [39]
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- Authors
- Rai, S., Foster, S., Griffiths, K. R., Breukelaar, I. A., Kozlowska, K., & Korgaonkar, M. S.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Kozlowska, Kasia
- ORCID
- Venue
- NeuroImage Clinical
- Publisher
- Elsevier BV
- Published
- 2022
- Volume
- 35
- Pages
- 103110
- ISSN
- 2213-1582 (ISSN-L)
- PMC
- PMC9421459
- OpenAlex
- W4285679618
- Cited by
- 35
- References
- 48
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 5 · 2023: 4 · 2022: 2
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- NeuroImage Clinical (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Westmead Institute for Medical Research
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- conversion disorder, resting-state functional connectivity, psychogenic non-epileptic seizures, HPA axis dysregulation, cortisol awakening response, heart rate, adverse childhood experiences, subjective distress, frontoparietal network, dorsal attention network, salience network, cerebellar network, language network, sensorimotor network
- MeSH terms
- Adolescent, Adult, Brain, Brain Mapping, Child, Conversion Disorder, Humans, Magnetic Resonance Imaging, Neural Pathways, Neural Networks, Computer
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