Functional neurological disorder is characterized by neurological symptoms that cannot be explained by typical neurological diseases or other medical conditions. This review will critically discuss the literature on the pathophysiology of functional movement disorders (FMD), including functional neuroimaging studies, neurophysiological studies, studies on biomarkers and genetic studies. According to PRISMA guidelines for systematic reviews, we selected 39 studies. A complex scenario emerged, with the involvement of different areas of the brain in the pathophysiology of FMD. Our findings showed a hypoactivation of the contralateral primary motor cortex, a decreased activity in the parietal lobe, an aberrant activation of the amygdala, an increased temporo-parietal junction activity and a hyperactivation of insular regions in patients with FMD. Functional connectivity (FC) findings underlined aberrant connections between amygdala and motor areas, temporo-parietal junction and insula. We proposed amygdala hyperactivation as a possible biological marker for FMD and FC alterations between amygdala and other areas of the brain as consequent epiphenomena, accounting for the pathophysiological complexity of FMD. These conclusions might drive novel treatment hypotheses.

功能性神经系统疾病的特征是神经系统症状，无法用典型的神经系统疾病或其他医学状况来解释。这篇评论将批判性地讨论功能性运动障碍（FMD）的病理生理学文献，包括功能性神经影像学研究，神经生理学研究，生物标志物研究和遗传研究。根据PRISMA的系统评价指南，我们选择了39项研究。出现了一个复杂的场景，大脑的不同区域参与了口蹄疫的病理生理。我们的研究结果表明，FMD患者对侧原发性运动皮层激活不足，顶叶活动减少，杏仁核异常激活，颞顶叶结合活动增加和岛状区域过度激活。功能连接性（FC）的发现强调了杏仁核与运动区域，颞顶顶交界处和绝缘之间的异常连接。我们提出杏仁核过度活化可能是FMD和杏仁核与大脑其他区域之间的FC改变的一种可能的生物学标记，从而引起表观现象，这说明了FMD的病理生理复杂性。这些结论可能会推动新颖的治疗假说。