In motor functional neurological disorders (mFND), relationships between interoception (a construct of high theoretical relevance to its pathophysiology) and neuroanatomy have not been previously investigated. This study characterized white matter in mFND patients compared to healthy controls (HCs), and investigated associations between fiber bundle integrity and cardiac interoception. Voxel-based analysis and tractography quantified fractional anisotropy (FA) in 38 mFND patients compared to 38 HCs. Secondary analyses compared functional seizures (FND-seiz; n = 21) or functional movement disorders (n = 17) to HCs. Network lesion mapping identified gray matter origins of implicated fiber bundles. Within-group mFND analyses investigated relationships between FA, heartbeat tracking accuracy and interoceptive trait prediction error (discrepancies between interoceptive accuracy and self-reported bodily awareness). Results were corrected for multiple comparisons, and all findings were adjusted for depression and trait anxiety. mFND and HCs did not show any between-group interoceptive accuracy or FA differences. However, the FND-seiz subgroup compared to HCs showed decreased integrity in right-lateralized tracts: extreme capsule/inferior fronto-occipital fasciculus, arcuate fasciculus, inferior longitudinal fasciculus, and thalamic/striatum to occipital cortex projections. These alterations originated predominantly from the right temporoparietal junction and inferior temporal gyrus. In mFND patients, individual differences in interoceptive accuracy and interoceptive trait prediction error correlated with fiber bundle integrity originating from the insula, temporoparietal junction, putamen and thalamus among other regions. In this first study investigating brain-interoception relationships in mFND, individual differences in interoceptive accuracy and trait prediction error mapped onto multimodal integration-related fiber bundles. Right-lateralized limbic and associative tract disruptions distinguished FND-seiz from HCs.

1st Department of Neurology Faculty of Medicine Masaryk University and St Anne's University Hospital Brno Czech Republic

Athinoula A Martinos Center for Biomedical Imaging Massachusetts General Hospital Harvard Medical School Charlestown Massachusetts USA

Department of Neurology Functional Neurological Disorder Research Program Behavioral Neurology Unit Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA

Department of Neurology School of Medicine University of Minnesota Minneapolis Minnesota USA

Department of Psychiatry Faculty of Medicine Masaryk University Brno and University Hospital Brno Brno Czech Republic

Department of Psychiatry Neuropsychiatry Unit Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA

Department of Psychology and Psychosomatics Faculty of Medicine Masaryk University and University Hospital Brno Brno Czech Republic

Gordon Center Department of Nuclear Medicine Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA

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Symptom-severity-related brain connectivity alterations in functional movement disorders

Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda