Functional and Structural Brain Imaging Correlates of Treatment Response in Functional Movement Disorder.

PURPOSE OF REVIEW: Functional movement disorder (FMD) is a biopsychosocially-complex condition with diverse neurologic, physical, and psychiatric manifestations. Converging neuroimaging evidence demonstrates abnormalities in networks supporting self-agency, attention, sensorimotor processing, multimodal integration, salience/threat detection, and interoception. This review summarizes recent work on the prognostic and therapeutic relevance of these findings. RECENT FINDINGS: Baseline functional neuroimaging predictors of outcome implicate cingulo-insular, frontolimbic, and subcortical circuits involved in attention, emotion regulation, and salience processing. Clinical improvement has been associated with activity changes in frontal premotor and regulatory regions, as well as in paralimbic areas. Preliminary studies of transcranial magnetic stimulation, transcranial direct-current stimulation, and neurofeedback suggest that targeted modulation of dysfunctional networks may alleviate symptoms. Neuroimaging features in FMD may inform outcome prediction, elucidate treatment-response mechanisms, and guide neuromodulation strategies. However, the field remains early in development, and larger, longitudinal studies are needed to translate these insights into routine clinical care.