{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T15:15:09Z","timestamp":1783178109093,"version":"3.54.6"},"reference-count":16,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,7,20]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>Functional neurological disorder (FND) presents with neurological symptoms lacking a structural correlate and is thought to result from brain network dysfunction. Despite advances in understanding its pathophysiology, several knowledge gaps exist. Spreading depolarisations (SDs), waves of cortical electrical disturbance best known in migraine aura and implicated in conditions like stroke and traumatic brain injury, have not been investigated in the context of FND. We present a patient with recurrent episodes of limb weakness and speech disturbances initially diagnosed as FND. Years later, following a left superficial temporal artery\u2013middle cerebral artery bypass, she developed similar symptoms. Intraoperative electrocorticography revealed SDs coinciding with symptom onset, and treatment with SD inhibitors led to clinical improvement. While further studies are needed to establish causality, this case highlights SD\u2019s as a plausible pathophysiological mechanism in a subset of patients with FND and underscores the need for future research exploring their contribution to FND symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2025-266260","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T06:20:14Z","timestamp":1754029214000},"page":"e266260","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Spreading depolarisation (SD): a potential underlying mechanism in functional neurological disorder (FND)"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7347-9524","authenticated-orcid":false,"given":"Divine Chibuzor","family":"Nwafor","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesarina","family":"Thohan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaitali","family":"Harge","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C William","family":"Shuttleworth","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University of New Mexico, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2025082723212642000_18.7.e266260.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00422-1"},{"key":"2025082723212642000_18.7.e266260.2","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1001\/jamaneurol.2020.3753","article-title":"Assessment of Emergency Department and Inpatient Use and Costs in Adult and Pediatric Functional Neurological Disorders","volume":"78","author":"Stephen","year":"2021","journal-title":"JAMA Neurol"},{"key":"2025082723212642000_18.7.e266260.3","doi-asserted-by":"crossref","DOI":"10.1038\/s41582-023-00821-2","article-title":"Author Correction: Why functional neurological disorder is not feigning or malingering","volume":"19","author":"Edwards","year":"2023","journal-title":"Nat Rev Neurol"},{"key":"2025082723212642000_18.7.e266260.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2015.08.004"},{"key":"2025082723212642000_18.7.e266260.5","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-43509-3"},{"key":"2025082723212642000_18.7.e266260.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2016.08.005"},{"key":"2025082723212642000_18.7.e266260.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09356-3"},{"key":"2025082723212642000_18.7.e266260.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.o64","article-title":"Diagnosis and management of functional neurological disorder","volume":"376","author":"Aybek","year":"2022","journal-title":"BMJ"},{"key":"2025082723212642000_18.7.e266260.9","doi-asserted-by":"publisher","DOI":"10.3171\/2017.12.JNS171665"},{"key":"2025082723212642000_18.7.e266260.10","doi-asserted-by":"crossref","DOI":"10.1126\/sciadv.adj2417","article-title":"Memantine inhibits cortical spreading depolarization and improves neurovascular function following repetitive traumatic brain injury","volume":"9","author":"MacLean","year":"2023","journal-title":"Sci Adv"},{"key":"2025082723212642000_18.7.e266260.11","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.549303"},{"key":"2025082723212642000_18.7.e266260.12","doi-asserted-by":"crossref","DOI":"10.3389\/fnins.2023.1197409","article-title":"Case report: Improvement in refractory functional seizures, depression, and quality of life with ketamine-assisted therapy","volume":"17","author":"Argento","year":"2023","journal-title":"Front Neurosci"},{"key":"2025082723212642000_18.7.e266260.13","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/YIC.0000000000000378","article-title":"Remission of functional motor symptoms following esketamine administration in a patient with treatment-resistant depression: a single-case report","volume":"37","author":"Moccia","year":"2022","journal-title":"Int Clin Psychopharmacol"},{"key":"2025082723212642000_18.7.e266260.14","doi-asserted-by":"crossref","DOI":"10.1177\/20451253211022187","article-title":"Improvement of functional neurological disorder after administration of esketamine nasal spray: a case report","volume":"11","author":"Vendrell-Serres","year":"2021","journal-title":"Ther Adv Psychopharmacol"},{"key":"2025082723212642000_18.7.e266260.15","doi-asserted-by":"crossref","unstructured":"Brown BR , Hund SJ , Easley KA , et al . Proof-of-Concept Validation of Noninvasive Detection of Cortical Spreading Depolarization with High Resolution Direct Current-Electroencephalography with Future Device Recommendations. medRxiv 2025. doi:10.1101\/2024.11.12.24311133","DOI":"10.1101\/2024.11.12.24311133"},{"key":"2025082723212642000_18.7.e266260.16","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2018.00017","article-title":"Detecting Cortical Spreading Depolarization with Full Band Scalp Electroencephalography: An Illusion?","volume":"9","author":"Hofmeijer","year":"2018","journal-title":"Front Neurol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266260","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:21:36Z","timestamp":1756362096000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":16,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,31]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bcr-2025-266260"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266260","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,31]]}}}