Are Functional (Psychogenic Nonepileptic) Seizures the Sole Expression of Psychological Processes?

Exploring psychedelic-assisted therapy in the treatment of functional seizures: A review of underlying mechanisms and associated brain networks

“…As shown in Table 1 , functional neuroimaging studies of patients with FS demonstrate multi-focal aberrations spanning several large-scale brain regions and networks. These observed network dysfunctions have the potential to provide a biological framework that accommodates the major factors described by the ICM and is supported elsewhere ( Sojka et al, 2022 ). However, studies to date have yielded heterogeneous findings that appear, at first glance, to be somewhat inconsistent, increases and decreases in activation of the rTPJ, cortical thickness, reactivity in the hippocampus, reactivity, and connectivity in the amygdala—likely reflecting a combination of the nonspecific limitations of functional neuroimaging studies ( Girn et al, 2023 ) and the clinical diversity of FS patients ( Table 1 ).…”

“…The so-called “integrative cognitive model” (ICM) has been proposed to unify these models and provide a more coherent framework for understanding the mechanisms underlying FS ( Reuber and Brown, 2017 ). This model, introduced by Reuber and Brown in 2017, posits that FS result from the interaction of biological, psychological, and social factors that predispose, precipitate, and perpetuate the disorder ( Reuber and Brown, 2017 ; Sojka et al, 2022 ). According to the ICM, the observable and subjective aspects of FS arise from the automatic enactment of a learned representation called the “seizure scaffold.” This seizure scaffold is shaped by intrinsic reflexes, physical symptoms (such as syncope, dissociation, and head injury), and knowledge or imitation of seizure-like behavior—together synthesizing the major factors described in previous models.…”

“…In addition, although several models have been proposed to explain the mechanisms of FS, none provide a complete account of the condition or its underlying cause ( Brown and Reuber, 2016b ; Hallett et al, 2022 ). Neuroimaging data have revealed a heterogeneous set of findings that implicate dysfunction across multiple large-scale networks, with connectivity abnormalities involving networks associated with emotional processing, attention, interoception, self-agency, and motor control ( Aybek and Perez, 2022 ; Balachandran et al, 2021 ; Ertan et al, 2022 ; Sojka et al, 2022 ; Szaflarski and LaFrance, 2018 ). The limitations of current diagnostic and treatment approaches, compounded by the lack of a unified mechanistic model, highlight the need for further research and exploration of novel interventions.…”

The neurobiology of functional neurological disorders characterised by impaired awareness

“…Active inference (269)(270)(271)(272)(273)(274)(275) posits that all organisms hold an implicit model of « how life should unfold », in terms of both homeostasis and development. Deviations, or expected deviations, from this scheme then motivate corrective processes, such as learning, moving or eating.…”

Neurostimulation for the treatment of functional neurological disorder: A systematic review

“…The original conversion disorder hypothesis suggested that psychological factors (i.e., traumatic and/or stressful events) are converted into neurological symptoms [3] . This has been abandoned in favor of a more comprehensive biopsychosocial framework that considers predisposing, precipitating and perpetuating risk factors [4] , [5] , [6] , [7] .…”