Modulating the sense of agency in functional neurological disorder using real-time fMRI neurofeedback: a proof-of-concept study
DOKPE
- Müller, Eliane ORCID University of Fribourg
- Loukas, Serafeim ORCID Ecole Polytechnique Fédérale de Lausanne (EPFL)
- Häuselmann, Salome ORCID University of Fribourg
- Concetti, Cristina ORCID University of Fribourg
- Van De Ville, Dimitri ORCID Ecole Polytechnique Fédérale de Lausanne
- Gninenko, Nicolas ORCID University of Fribourg
- Aybek, Selma ORCID University of Fribourg
- 2025
Published in:
- NeuroImage: Clinical. - Elsevier BV. - 2025, vol. 48, p. 103899
Functional MRI
Neurofeedback
Functional neurological disorder
Sense of agency
Temporoparietal junction
English
Background: Disrupted sense of agency (SoA), the perceived loss of control over one’s actions, is common in functional neurological disorder (FND) and linked to abnormal activation in agency-related networks, particu- larly the right temporoparietal junction (rTPJ). This proof-of-concept study tested whether fMRI neurofeedback (NF) could enhance SoA in FND by targeting the rTPJ.
Methods: In this single-arm feasibility study, 18 patients with mixed FND symptoms completed three NF trainings during an adaptive visuomotor task, receiving intermittent visual feedback of their rTPJ activity. Pre- and post- training assessments included subjective agency ratings, neuroimaging during a transfer task, and clinical evaluations.
Results: Group-level subjective agency significantly increased after training (p = 0.0083), driven by responders (n = 8) who exhibited rTPJ (p = 0.042) and supplementary motor area (SMA) upregulation (p = 0.015) in the first session, alongside consistent task engagement. Behavioral gains coincided with trend-level decreases in rTPJ–dorsolateral prefrontal cortex (dlPFC) connectivity (p = 0.098), while non-responders showed reduced rTPJ–SMA connectivity (p = 0.008). No group-level clinical improvements were observed, but higher initial rTPJ (p = 0.03, ρ = –0.78) and dlPFC (p = 0.03, ρ = –0.75) activation were negatively associated with changes in self- reported core symptoms.
Conclusion: NF from rTPJ activity is feasible in FND and may enhance explicit SoA in a subset of patients through early neural modulation and sustained engagement. High inter-individual variability underscores the need for sham-controlled trials with optimized, engaging feedback designs and longitudinal monitoring to identify pa- tients who could benefit from NF.
Methods: In this single-arm feasibility study, 18 patients with mixed FND symptoms completed three NF trainings during an adaptive visuomotor task, receiving intermittent visual feedback of their rTPJ activity. Pre- and post- training assessments included subjective agency ratings, neuroimaging during a transfer task, and clinical evaluations.
Results: Group-level subjective agency significantly increased after training (p = 0.0083), driven by responders (n = 8) who exhibited rTPJ (p = 0.042) and supplementary motor area (SMA) upregulation (p = 0.015) in the first session, alongside consistent task engagement. Behavioral gains coincided with trend-level decreases in rTPJ–dorsolateral prefrontal cortex (dlPFC) connectivity (p = 0.098), while non-responders showed reduced rTPJ–SMA connectivity (p = 0.008). No group-level clinical improvements were observed, but higher initial rTPJ (p = 0.03, ρ = –0.78) and dlPFC (p = 0.03, ρ = –0.75) activation were negatively associated with changes in self- reported core symptoms.
Conclusion: NF from rTPJ activity is feasible in FND and may enhance explicit SoA in a subset of patients through early neural modulation and sustained engagement. High inter-individual variability underscores the need for sham-controlled trials with optimized, engaging feedback designs and longitudinal monitoring to identify pa- tients who could benefit from NF.
- Faculty
- Faculté des sciences et de médecine
- Department
- Section de médecine
- Language
-
- English
- Classification
- Pathology, clinical medicine
- Other electronic version
- License
-
CC BY
- Open access status
- gold
- Identifiers
-
- DOI 10.1016/j.nicl.2025.103899
- ISSN 2213-1582
- Persistent URL
- https://folia.unifr.ch/unifr/documents/333520
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