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DOI: 10.1055/a-2764-3644
Autonomic Disorders and FND
Autor*innen
Abstract
Functional neurological disorders (FNDs) are neurological conditions resulting from altered brain network activity causing physical symptoms that are genuine but not explained by structural changes in the brain. FND results from abnormal connectivity in the limbic system and overlapping circuitry dysfunction in salience networks. The autonomic nervous system (ANS) refers to the part of the nervous system devoted to unconscious processes, the viscera and homeostasis. The ANS has afferent pathways, central nuclei and networks, and efferent pathways. Since unconscious neural processing and automatic behaviors are under the purview of the ANS, there is great interest in understanding the role of abnormal ANS activity in FND. To date, the overlap between ANS dysfunction and FND has been relatively underexplored. Here, we discuss the role of the ANS in FND and the overlap between autonomic dysfunction and FND.
Publikationsverlauf
Eingereicht: 11. November 2025
Angenommen: 04. Dezember 2025
Artikel online veröffentlicht:
31. Dezember 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- 1 Barboi AC, Macefield VG. The autonomic nervous system: time for a conceptual reframing?. J Physiol 2025; 603 (22) 6719-6731
- 2 Espay AJ, Aybek S, Carson A. et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol 2018; 75 (09) 1132-1141
- 3 Pick S, Goldstein LH, Perez DL, Nicholson TR. Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. J Neurol Neurosurg Psychiatry 2019; 90 (06) 704-711
- 4 Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol 2022; 21 (06) 537-550
- 5 Benarroch EE. The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc 1993; 68 (10) 988-1001
- 6 Prescott SL, Liberles SD. Internal senses of the vagus nerve. Neuron 2022; 110 (04) 579-599
- 7 Berntson GG, Khalsa SS. Neural circuits of interoception. Trends Neurosci 2021; 44 (01) 17-28
- 8 Freeman R, Chapleau MW. Testing the autonomic nervous system. Handb Clin Neurol 2013; 115: 115-136
- 9 Perez DL, Matin N, Barsky A. et al. Cingulo-insular structural alterations associated with psychogenic symptoms, childhood abuse and PTSD in functional neurological disorders. J Neurol Neurosurg Psychiatry 2017; 88 (06) 491-497. Erratum in: J Neurol Neurosurg Psychiatry. 2017 Dec;88(12):1098
- 10 Gorman JM, Kent JM, Sullivan GM, Coplan JD. Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry 2000; 157 (04) 493-505
- 11 Benarroch EE. Insular cortex: functional complexity and clinical correlations. Neurology 2019; 93 (21) 932-938
- 12 AbuHasan Q, Reddy V, Siddiqui W. Neuroanatomy, Amygdala. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Jan–. Updated 2023 Jul 17. Accessed December 18, 2025 at: https://www.ncbi.nlm.nih.gov/books/NBK537102/
- 13 Baykara M, Baykara S, Atmaca M. Magnetic resonance imaging histogram analysis of amygdala in functional neurological disorder: histogram analysis of amygdala in functional neurological disorder. Psychiatry Res Neuroimaging 2022; 323: 111487
- 14 Bhatnagar S, Vining C, Denski K. Regulation of chronic stress-induced changes in hypothalamic-pituitary-adrenal activity by the basolateral amygdala. Ann N Y Acad Sci 2004; 1032: 315-319
- 15 Perez DL, Nicholson TR, Asadi-Pooya AA. et al. Neuroimaging in runctional neurological disorder: state of the field and research agenda. Neuroimage Clin 2021; 30: 102623
- 16 Chen Z, Tao S, Zhu R. et al. Aberrant functional connectivity between the suprachiasmatic nucleus and the superior temporal gyrus: bridging RORA gene polymorphism with diurnal mood variation in major depressive disorder. J Psychiatr Res 2021; 132: 123-130
- 17 Drane DL, Fani N, Hallett M, Khalsa SS, Perez DL, Roberts NA. A framework for understanding the pathophysiology of functional neurological disorder. CNS Spectr 2020; 1-7 . Epub ahead of print.
- 18 Slovák M, Anýž J, Erlebach J. et al. Emotional arousal in patients with functional movement disorders: a pupillometry study. J Psychosom Res 2022; 162: 111043
- 19 Schwartz PJ. Freud's 1926 conjecture is confirmed: evidence from the dorsal periaqueductal gray in mice that human psychological defense against internal instinctual threat evolved from animal motor defense against external predatory threat. Front Psychol 2024; 15: 1427816
- 20 Thompson JM, Neugebauer V. Cortico-limbic pain mechanisms. Neurosci Lett 2019; 702: 15-23
- 21 Zhang H, Zhu Z, Ma WX. et al. The contribution of periaqueductal gray in the regulation of physiological and pathological behaviors. Front Neurosci 2024; 18: 1380171
- 22 Huang TX, Wang S, Ran C. Interoceptive processing in the nucleus of the solitary tract. Curr Opin Neurobiol 2025; 93: 103021
- 23 Zoccal DB, Furuya WI, Bassi M, Colombari DS, Colombari E. The nucleus of the solitary tract and the coordination of respiratory and sympathetic activities. Front Physiol 2014; 5: 238
- 24 Guyenet PG, Stornetta RL. Rostral ventrolateral medulla, retropontine region and autonomic regulations. Auton Neurosci 2022; 237: 102922
- 25 Voon V, Brezing C, Gallea C. et al. Emotional stimuli and motor conversion disorder. Brain 2010; 133 (Pt 5): 1526-1536
- 26 Diez I, Ortiz-Terán L, Williams B. et al. Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder. J Neurol Neurosurg Psychiatry 2019; 90 (08) 929-938
- 27 Li R, Li Y, An D, Gong Q, Zhou D, Chen H. Altered regional activity and inter-regional functional connectivity in psychogenic non-epileptic seizures. Sci Rep 2015; 5: 11635
- 28 Kaufmann H. Neurally mediated syncope and syncope due to autonomic failure: differences and similarities. J Clin Neurophysiol 1997; 14 (03) 183-196
- 29 Palma J-A, Benarroch EE. Neural control of the heart: recent concepts and clinical correlations. Neurology 2014; 83 (03) 261-271
- 30 Paredes-Echeverri S, Maggio J, Bègue I, Pick S, Nicholson TR, Perez DL. Autonomic, endocrine, and inflammation profiles in functional neurological disorder: a systematic review and meta-analysis. J Neuropsychiatry Clin Neurosci 2022; 34 (01) 30-43
- 31 Novak P, Systrom DM, Marciano SP. et al. Mismatch between subjective and objective dysautonomia. Sci Rep 2024; 14 (01) 2513
- 32 van Zijderveld GA, Veltman DJ, van Dyck R, van Doornen LJ. Epinephrine-induced panic attacks and hyperventilation. J Psychiatr Res 1999; 33 (01) 73-78
- 33 Beutler S, Mertens YL, Ladner L, Schellong J, Croy I, Daniels JK. Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients. Eur J Psychotraumatol 2022; 13 (02) 2132599
- 34 Reinsberger C, Perez DL, Murphy MM, Dworetzky BA. Pre- and postictal, not ictal, heart rate distinguishes complex partial and psychogenic nonepileptic seizures. Epilepsy Behav 2012; 23 (01) 68-70
- 35 Goldstein DS, Holmes C, Frank SM. et al. Sympathoadrenal imbalance before neurocardiogenic syncope. Am J Cardiol 2003; 91 (01) 53-58
- 36 Benditt DG, van Dijk JG, Krishnappa D, Adkisson WO, Sakaguchi S. Neurohormones in the pathophysiology of vasovagal syncope in adults. Front Cardiovasc Med 2020; 7: 76
- 37 Blitshteyn S, Treisman GJ, Ruhoy IS. et al. Postural orthostatic tachycardia syndrome and other common autonomic disorders are not functional neurologic disorders. Front Neurol 2024; 15: 1490744
- 38 Freeman R, Wieling W, Axelrod FB. et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21 (02) 69-72
- 39 Green EA, Raj V, Shibao CA. et al. Effects of norepinephrine reuptake inhibition on postural tachycardia syndrome. J Am Heart Assoc 2013; 2 (05) e000395
- 40 Stone J, Coebergh J, Khoja L, Butler M, Nicholson TR, Dodick DW. Migraine and functional neurological disorder (FND)—a review of comorbidity and potential overlap. Brain Commun 2025; 7 (04) fcaf288
- 41 Boylan KA, Dworetzky BA, Baslet G, Polich G, Angela O'Neal M, Reinsberger C. Functional neurological disorder, physical activity and exercise: what we know and what we can learn from comorbid disorders. Epilepsy Behav Rep 2024; 27: 100682
- 42 Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci 2018; 215: 20-27
- 43 Gibbons CH, Bonyhay I, Benson A, Wang N, Freeman R. Structural and functional small fiber abnormalities in the neuropathic postural tachycardia syndrome. PLoS One 2013; 8 (12) e84716
- 44 Novak P, Marciano SP, Witte A. Role of central sensitization syndrome in patients with autonomic symptoms. Neurol Clin Pract 2025; 15 (03) e200463. Erratum in: Neurol Clin Pract. 2025 Aug;15(4): e200490
- 45 Kanjwal K, Karabin B, Sheikh M. et al. Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience. Pacing Clin Electrophysiol 2011; 34 (06) 750-755
- 46 Rektorová I, Pupíková M, Fleury L, Brabenec L, Hummel FC. Non-invasive brain stimulation: current and future applications in neurology. Nat Rev Neurol 2025; 21 (12) 669-686