Can neurofeedback help functional neurological disorder?

Functional neurological disorder is a condition in which individuals experience neurological symptoms that cannot be fully explained by structural damage to the nervous system. However, the symptoms are genuine, involuntary and often highly disabling.

The incidence of FND was estimated at 10-22/100 000, while the minimum prevalence of FND was estimated at 80-140/100 000, with a possible range of 50-1600/100 000. Incidence of paediatric FND was estimated to be between 1 and 18/100 000 [1].

FND was not an official diagnosis until 2013, when it appeared in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [2]. Historically referred to as "conversion disorder", FND is now recognised as a distinct neurological condition involving alterations in brain function rather than brain anatomy [3].

Although the exact causes of FND remain under investigation, researchers increasingly view the condition through the lens of network neuroscience, exploring how disruptions in communication between brain regions may contribute to symptoms [4].

Living with functional neurological disorder can feel overwhelming, as most tests come back normal whereas your body insists otherwise. Legs can refuse to move, hands tremble or vision blurs. The absence of visible damage on an MRI can question the reality of the experience.

Neuroscience is gradually lifting the fog of confusion and isolation, as it shows that the problem lies in how the brain networks talk to one another rather than in physical lesions.

Modern neuroimaging studies suggest that FND involves alterations in networks responsible for attention, emotional processing, motor control and self-awareness [6].

Some researchers describe FND as a disorder of prediction and perception. In everyday life, the brain constantly predicts sensory information and compares those predictions with incoming signals from the body. When these processes become disrupted, movements, sensations or symptoms may be experienced as involuntary even though the underlying motor pathways remain intact [4][6].

Researchers have identified differences in connectivity between regions involved in:

movement planning and execution;

emotion processing;

salience detection;

self-referential thinking;

sense of agency.

The sense of agency refers to the feeling that we are initiating and controlling our own actions. Some studies suggest that altered processing within these networks may contribute to the mismatch between intention and movement often observed in FND [6].

Large-scale brain networks such as the Default Mode Network (DMN), Salience Network and Executive Control Network have become increasingly important areas of investigation. These networks help coordinate internal thoughts, attention and behavioural responses, making them relevant targets for future neuromodulation approaches.