{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:08:16Z","timestamp":1768568896358,"version":"3.49.0"},"posted":{"date-parts":[[2025,6,6]]},"group-title":"Neurology","reference-count":67,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,6,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Neuroimaging studies of functional neurological disorder (FND), a condition at the intersection of psychiatry and neurology, often rely on discrete connections or parcellations that may obscure the brain\u2019s functional network architecture. This study applied a gradient-based approach to examine macroscale cortical organization in FND.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We analyzed resting-state functional magnetic resonance imaging (fMRI) data from 64 patients with mixed FND (FND-mixed), 61 age- and sex-matched healthy controls (HCs), and 62 psychiatric controls (PCs) matched on age, sex, depression, anxiety, and post-traumatic stress disorder (PTSD) severity. Functional connectivity gradients were computed to capture dominant axes of cortical organization. Between-group comparisons were conducted for the top three gradients, and associations with symptom severity were investigated. Subtype-specific patterns in functional motor disorder (n=49) and functional seizure (n=24) were also examined. Analyses controlled for age, sex, and antidepressant use, and were\n                    <jats:italic>post-hoc<\/jats:italic>\n                    adjusted for depression, anxiety, and PTSD-severity, and for childhood maltreatment.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The FND-mixed group showed alterations across all three gradients relative to HCs and PCs. Gradient 1 revealed increased values in sensorimotor regions, reflecting a shift toward more association-like connectivity. Gradient 2 showed altered differentiation between sensory systems. Gradient 3 exhibited reduced functional separation between representational and modulatory regions, with prominent shifts in the anterior cingulate cortex. Several regions displaying between-group differences also showed correlations with FND and somatic symptom severity. Analyses revealed overlapping and distinct patterns across subtypes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We provide novel evidence of atypical hierarchical brain organization in FND, highlighting gradient-based approaches for identifying mechanistically-relevant altered functional brain organization.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.06.05.25328981","type":"posted-content","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T23:00:14Z","timestamp":1749250814000},"source":"Crossref","is-referenced-by-count":0,"title":["Functional Connectivity Gradients Reveal Altered Hierarchical Cortical Organization in Functional Neurological 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