5-HT2A Agonists: A Novel Therapy for Functional Neurological Disorders?

Functional neurological disorders are common, have poor outcomes, and few treatments exist. Their cause is unknown, but leading theories suggest a disturbance in how the mind represents the body, with abnormal top-down cognitive influences on sensorimotor function despite intact neural pathways. Recent studies indicate that 5-HT2A agonists, such as psychedelics, alter brain activity in ways that disrupt hierarchical dynamics and modulate networks involved in self-processing. Converging evidence suggests these agents may hold unique therapeutic potential for these disorders. Given the personal and societal burden, the authors argue a clinical trial to test this hypothesis is warranted.

Study at a glance

Abstract

Functional neurological disorders are frequently encountered in clinical practice. They have a poor prognosis and treatment options are limited. Their etiology is unknown, but leading theories propose a disturbance of somatic self-representation: the mind perceives dysfunction of a body region despite intact motor and sensory pathways. Central to this model is the concept of an abnormal top-down cognitive influence upon sensorimotor function. There is growing interest in the use of 5-HT2A agonists in the management of neuropsychiatric conditions. Recent studies have shown that these agents induce changes in neural activity that disrupt hierarchical brain dynamics and modulate networks subserving self-related processing. Converging evidence suggests they may hold unique therapeutic potential in functional neurological disorders. This is of importance given the considerable personal and societal burden of this condition and we argue a clinical trial to test this hypothesis is warranted.