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National audience; OBJECTIVES: Functional neurological disorders have witnessed intense research activity in the fields of structural and functional neuroimaging for more than twenty years. Thus, we propose a synthesis of recent research findings and etiological hypotheses that have been proposed so far. This work should help clinicians to better understand the nature of the mechanisms involved, but also help patients to increase their knowledge about the biological features underlying their functional symptoms. METHODS: We carried out a narrative review of international publications dealing with neuroimaging and biology of functional neurological disorders, from 1997 to 2023. RESULTS: Several brain networks underlie functional neurological symptoms. These networks play a role in the management of cognitive resources, in attentional control, emotion regulation, in agency and in the processing of interoceptive signals. The mechanisms of the stress response are also associated with the symptoms. The biopsychosocial model helps to better understand predisposing, precipitating, and perpetuating factors involved. The functional neurological phenotype results from the interaction between: i) a specific pre-existing vulnerability resulting from biological background and epigenetic modifications, and ii) exposure to stress factors, according to the stress-diathesis model. This interaction causes emotional disturbances including hypervigilance, lack of integration of sensations and affects, and emotional dysregulation. These characteristics in turn impact the cognitive, motor and affective control processes related with the functional neurological symptoms. CONCLUSIONS: A better knowledge of the biopsychosocial determinants of brain network dysfunctions is necessary. Understanding them would help developing targeted treatments, but is also critical for patients care.

National audience; Les troubles neurologiques fonctionnels (TNF) ont longtemps constitué un défi pour la médecine, tant au niveau clinique que psychodynamique. La question médico-légale semble avoir été reléguée au second plan du fait des difficultés diagnostiques et ses liens avec de nombreuses comorbidités somatiques ou psychiatriques en dépit d’un handicap important et d’une altération de la qualité de vie similaire à certaines pathologies neurodégénératives. Que ce soit pour l’estimation d’un dommage corporel, d’un préjudice ou de séquelles à la suite d’un accident médical ou certains contextes juridiques demandant d’éliminer un trouble factice ou une simulation, l’incertitude et l’imprécision peuvent avoir des conséquences notables pour le patient. Dans cet article, nous proposons de définir les différents contextes médico-légaux dans lesquels peuvent s’inscrire les TNF, d’expliquer comment avoir recours à des outils d’évaluation objectifs standardisés validés et l’évaluation croisée pluridisciplinaire et enfin nous détaillons comment différencier ce trouble des autres pathologies proches cliniquement. Outre la réalisation rigoureuse de missions d’expertise, cela permettra de réduire deux conséquences dommageables caractérisant le TNF, à savoir l’errance diagnostique et la souffrance engendrée par la stigmatisation des patients avec TNF.

After more than twenty years of academic research on functional neurological disorders (FND) throughout the world, a standardized care management strategy has emerged to allow a more adapted care offer to patients with FND, as close as possible to their experience and their needs. With regard to this special issue on FND in collaboration with L'Encéphale and at the initiative of the Neuropsychiatry section of the AFPBN (French Association of Biological Psychiatry and Neuropsychopharmacology), we would like to suggest a summary of all topics discussed in more detail in each article of this special issue, in order to facilitate its reading. We therefore cover the following themes: the initial contact with a patient with FND, the diagnostic process in favor of a positive diagnosis, the physiological, neural and psychological basis of FND, the diagnostic announcement (and its intangibles), the therapeutic patient education in FND, the general principles of therapeutic management through a personalized and multidisciplinary care program, and the validated therapeutic tools available according to the symptoms identified. This article is designed to be of broad interest on FND, supported by tables and figures showing the key points of all these steps, to keep an educational purpose at most. We hope that through this special issue, each health professional will be able to grasp this knowledge and this framework of care as easily and quickly as possible, in order to participate in the standardization of the care offer.

Additional file 1: Place of the partial dopamine receptor agonist aripiprazole in themanagement of schizophrenia in adults: a Delphi consensus study. Additional Table 1. Evidence level classification of the Frenchhealth authorities. Additional Table 2. Studies identified in the literature review. Additional Table 3. Questions asked in the Delphisurvey. Additional Table 4. Examples of verbatim from theDelphi survey. Additional Figure 1. PRISMAflow diagram for the literature search.