Neuroimaging-Based Guidance for Ultrasound Neuromodulation in Functional Movement Disorder

Motor control arises from dynamic interactions among distributed brain networks that integrate cognitive, sensory, and autonomic processes. Among these, the Action-Mode Network (AMN; formerly the cingulo-opercular network) and the Somato-Cognitive Action Network (SCAN) are central for initiating and sustaining goal-directed behavior. The AMN orchestrates global action readiness by coordinating arousal, attention, and motor planning, whereas the SCAN executes whole-body motor output in concert with physiological adjustments. In Functional Movement Disorders (FMD), impaired AMN–SCAN coupling may disrupt the automatic integration of intention and movement, resulting in abnormal motor output and loss of agency. To address this, we propose a neurorehabilitation framework that combines action observation, motor imagery, and motor execution in conjunction with ultrasound neuromodulation of the AMN–SCAN interface at the dorsal anterior cingulate cortex (dACC)–supplementary motor complex (SMC). Neuroimaging-guided neuromodulation of the dACC–SMC integrated with biofeedback training has the potential to restore flexible network transitions between default-mode and action-mode states, normalize efferent signaling, and reduce oscillatory motor errors. This network-level approach reframes FMD as a disorder of brain–body state transitions and identifies a testable target for neuromodulation.