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Functional neurological disorder: new subtypes and shared mechanisms
Open accessAbstract
Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional neurological disorder, but are often absent. Four entities-functional seizures, functional movement disorders, persistent perceptual postural dizziness, and functional cognitive disorder-show similarities in aetiology and pathophysiology and are variants of a disorder at the interface between neurology and psychiatry. All four entities have distinctive features and can be diagnosed with the support of clinical neurophysiological studies and other biomarkers. The pathophysiology of functional neurological disorder includes overactivity of the limbic system, the development of an internal symptom model as part of a predictive coding framework, and dysfunction of brain networks that gives movement the sense of voluntariness. Evidence supports tailored multidisciplinary treatment that can involve physical and psychological therapy approaches.
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“Early adverse life experiences, negative affectivity, neuroticism, depression, and anxiety have been identified as psycho logical predisposing conditions for persistent physical symptoms”
From Persistent physical symptoms: definition, genesis, and management (2024) · cites this paper as [69]
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“Common biomedical factors, such as persistent inflammation and dysregulation of the immune, autonomic, metabolic, and microbiome systems, as well as genetic and epigenetic factors, can cause somatic symptoms to persist or intensify”
From Persistent physical symptoms: definition, genesis, and management (2024) · cites this paper as [69]
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Cope, S. R., James, B., Vanzan, S., Smith, J. G., El‐Leithy, S., Edwards, M. J., Hogwood, P., Turner, K. J., Golder, D., & Billings, J. (2026) · BJPsych Open · doi:10.1192/bjo.2026.12060
Treatment of Functional Neurological Disorders
Park, J. E. (2026) · Journal of Clinical Neurology · doi:10.3988/jcn.2026.0223
Bukovsky, D., Song, J., Shewchuk, H., Carmona-Torres, E., Crawford, E., Dillon, W., Graff‐Guerrero, A., Kyte, S., Rutka, J. A., Sulway, S., et al. (2026) · Journal of Vestibular Research · doi:10.1177/09574271261468395
Metadata
- Authors
- Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J.
- Affiliations
- National Institutes of Health (US)
- University Hospital of Bern (CH)
- Brigham and Women's Hospital (US)
- University of Edinburgh (GB)
- Mayo Clinic (US)
- Corresponding author
- Hallett, Mark
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 21
- Issue
- 6
- Pages
- 537-550
- ISSN
- 1474-4422 (ISSN-L)
- PMC
- PMC9107510
- OpenAlex
- W4223971211
- Cited by
- 538
- References
- 128
- Citations by year
- 2026: 154 · 2025: 159 · 2024: 126 · 2023: 81 · 2022: 17
- FWCI
- 16.48
- Type
- journal article
- Language
- en
- Update notices
- erratum (2022-06-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Neurology (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- National Institute of Neurological Disorders and Stroke
- U.S. Army Medical Research and Development Command
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PP00P3_176985)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Keywords
- conversion disorder, psychogenic non-epileptic seizures, functional movement disorders, functional cognitive disorder, psychological stress, predictive coding, brain network dysfunction, neurophysiological markers, multidisciplinary treatment
- MeSH terms
- Brain, Conversion Disorder, Humans, Seizures
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