Recipient organisationNIHR University College London Hospitals Biomedical Research Centre
NIHR supportRecorded as supported by this research centre
PeriodFeb 2025 — Nov 2025
In plain English
AI plain-English summary
People with functional seizures often feel their body slip out of their control, as if they are no longer driving it. This project investigates whether a disrupted ability to sense internal bodily signals—like heartbeats—helps explain that loss of agency. The problem is that current treatments for functional seizures are limited because the underlying mechanisms remain poorly understood. While researchers know that interoception (the brain’s sensing of internal body states) is impaired in these patients, no one has directly tested how that impairment links to the feeling of disembodiment during a seizure. This study fills that gap by measuring how accurately patients perceive their heartbeats, and whether that accuracy relates to their sense of control. If successful, the research could reveal a measurable biological marker for seizure vulnerability, potentially guiding new therapies that retrain interoceptive awareness. In the longer term, understanding how heartbeat timing modulates pain perception might also inform better pain management strategies for this group. The work is primarily fundamental science—it aims to clarify a poorly understood mechanism rather than deliver an immediate clinical tool—but similar insights into interoception have already opened paths for treating anxiety and dissociative disorders.
View original technical description
Functional Seizures (FS) are thought to occur by the brain “shutting down” through temporary dissociation. However, the underlying mechanisms are poorly understood. Recent research has shown that interoception - how the nervous system senses, interprets and integrates information inside the body (e.g. from the heart or lungs) – is linked to FS. For example, our group recently demonstrated that individuals with FS (IWFS) have an impaired ability to perceive their bodily signals compared to individuals without FS. Moreover, the difference between IWFS’s objective sensitivity to interoceptive information as measured by their ability to sense their heartbeats accurately, and their insight into how accurate they are, correlates with seizure frequency after correcting for levels of anxiety and depression. A feature of functional seizures is that the patient does not feel in control of their body (a loss of a sense of agency) when they have a seizure. Our group demonstrated a link between the sense of agency and interoception in individuals without FS. We aim to extend that work into the patient group. We will use well-described tasks to examine the interoceptive accuracy and the sense of agency. IWFS also feel disembodied (the feeling of not being in their body) during their seizures and report altered sensory perception of painful and pleasant stimuli. Therefore, we plan to explore how changes in embodiment modulate the participants' perception of a pleasant stimulus, using an augmented reality headset and a soft brush. We will also investigate how interoceptive signals affect unpleasant or painful stimuli. Here we will use painful stimuli timed with, or between heartbeats. We will see whether the presence or absence of the heartbeats (the presence or absence of interoceptive signalling) modulate the perception of the pain. Participants will also complete several self-report questionnaires, which include measurements of depression, anxiety, and dissociation.
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