Neuroplastic changes in patients with functional seizures following neurobehavioral therapy, 2025, Sharma et al.

Neuroplastic changes in patients with functional seizures following neurobehavioral therapy
Sharma; Allendorfer; Correia; Gaston; Goodman; Grayson; Philip; LaFrance; Szaflarski

Given the high prevalence of functional neurological symptom disorder and its negative effects on the individual, family, and society, the development of interventions to treat it—including the subtype of functional seizures (FS)—is critical. Although we have limited understanding of the neurobiological effects of neurobehavioral therapy (NBT), studies indicate that NBT reduces seizures and improves psychological comorbidities in FS.

In this study, healthy adults (N = 33) and patients with a history of TBI with (TBI-FS; N = 50) and without FS (TBI-only; N = 50) underwent magnetic resonance imaging (MRI) at 3 T approximately 12 weeks apart. TBI-FS participants underwent up to 12 sessions of NBT between scans. Structural MRI data were analyzed using voxel-based morphometry. A voxelwise repeated measures ANOVA tested changes in grey matter volume (GMV) between groups over time.

Following treatment with NBT, TBI-FS participants showed a 1.23 % GMV increase in the left inferior and middle temporal gyri (pFWE < 0.05) along with a 35.78 % reduction in seizure events and decrease in depressive (p < 0.001) and anxiety (p = 0.01) symptoms. Left temporal GMV increases were directly associated (p = 0.04, r = 0.26) with improvements in overall psychological, social, and occupational functioning (p < 0.001).

We observed structural brain changes within the left inferior temporal gyrus following NBT that correspond to functional and psychological improvements in patients with TBI-FS. This work highlights the need for further research into the neurobiological effects of NBT, building on the relationship between NBT and brain plasticity and demonstrating putative targets for interventions.

HIGHLIGHTS
• Neurobehavioral therapy (NBT) reduces functional seizures.

• No previous study has investigated structural brain changes underlying NBT’s effects.

• In this study, left temporal grey matter volume increased in patients with FS after NBT.

• Gray matter increases were linked to better psychological health.

• NBT may boost brain plasticity in patients with functional seizures.

Link (NeuroImage: Clinical) [Open Access]

 

FND researchers might have crossed the structural Rubicon. Not sure where that leaves the "it's software not hardware" people.

The authors did note the absence of a control group. But they're convinced nonetheless.

 

I'm not sure if we just have a bad batch of studies today or if I am just grumpy. But, for goodness sake.

A mean 1.23% change in the grey matter of a bit of the brain, in imaging taken 3 months apart? That's virtually nothing.
This is what AI has to say about that, and I support it:

And, yeah, NO CONTROL. There's a lot going on in this study, but most of it is window dressing. A lot of action but without a relevant control we can't actually know if the observed changes have anything to do with the treatment.

There's a lot more that could be said, even just based on the abstract.

 

As a result, behavioral and neuroimaging studies of FS have revealed a spectrum of structural, functional, genetic, and neuroinflammatory abnormalities in brain regions crucial for inhibition, executive control, emotion regulation, and sensorimotor processing.​

Doesn't sound functional to me.