CONVERSION SYNDROME: NEUROPHYSIOLOGICAL MECHANISMS, DIAGNOSTIC CRITERIA AND MULTIDISCIPLINARY THERAPEUTIC INTERVENTIONS

Abstract

Conversion Syndrome, also known as Functional Neurological Disorder (FND), is characterized by motor and sensory dysfunctions not explained by structural neurological conditions. Although its etiology is complex and multifactorial, recent advances in neuroscience have allowed a better understanding of its neurophysiological mechanisms, involving functional alterations in neuronal connectivity and the hypothalamic-pituitary-adrenal axis. However, diagnostic challenges persist, and the effectiveness of multidisciplinary therapeutic approaches still requires greater systematization. This integrative review aims to analyze the neurophysiological mechanisms involved in Conversion Syndrome, describe the diagnostic criteria used in clinical practice, and review the main multidisciplinary therapeutic interventions available. The methodology followed the integrative review guidelines, with a systematic search in the PubMed, Scopus, Web of Science, PsycINFO, and SciELO databases, using descriptors indexed in MeSH and DeCS. Studies published in the last 10 years, in Portuguese, English and Spanish, that addressed neurophysiological, diagnostic and therapeutic aspects of the condition were included. The results indicate that conversion syndrome is associated with changes in the connectivity between cortical and subcortical networks, with imbalance in emotional and motor regulation, in addition to dysfunction of the neuroendocrine axis and neural plasticity. Regarding diagnosis, the DSM-5 and ICD-11 criteria are the most commonly used, being complemented by functional neuroimaging findings (fMRI, SPECT, PET), electroneuromyography and neuropsychological evaluation to exclude other neurological pathologies. The therapeutic interventions analyzed suggest that multidisciplinary approaches are essential for the rehabilitation of patients. Strategies such as Cognitive-Behavioral Therapy (CBT), motor physiotherapy, occupational therapies and neuromodulation techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have shown a positive impact on functional recovery. Pharmacological treatment targeting associated psychiatric comorbidities, such as depression and anxiety, has also proven to be relevant. It is concluded that an interdisciplinary approach is essential for the treatment of conversion syndrome, requiring accurate diagnosis and personalized therapeutic interventions. Further research into neurophysiological mechanisms and innovative therapeutic strategies may contribute to more effective management and to improving patients' quality of life.