1
|
van der Kruijs SJM, Vonck KEJ, Langereis GR, Feijs LMG, Bodde NMG, Lazeron RHC, Carrette E, Boon PAJM, Backes WH, Jansen JFA, Aldenkamp AP, Cluitmans PJM. Autonomic nervous system functioning associated with psychogenic nonepileptic seizures: Analysis of heart rate variability. Epilepsy Behav 2016; 54:14-9. [PMID: 26615481 DOI: 10.1016/j.yebeh.2015.10.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/24/2015] [Accepted: 10/10/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Psychogenic nonepileptic seizures (PNESs) resemble epileptic seizures but originate from psychogenic rather than organic causes. Patients with PNESs are often unable or unwilling to reflect on underlying emotions. To gain more insight into the internal states of patients during PNES episodes, this study explored the time course of heart rate variability (HRV) measures, which provide information about autonomic nervous system functioning and arousal. METHODS Heart rate variability measures were extracted from double-lead electrocardiography data collected during 1-7days of video-electroencephalography monitoring of 20 patients with PNESs, in whom a total number of 118 PNESs was recorded. Heart rate (HR) and HRV measures in time and frequency domains (standard deviation of average beat-to-beat intervals (SDANN), root mean square of successive differences (RMSSD), high-frequency (HF) power, low-frequency (LF) power, and very low-frequency (VLF) power) were averaged over consecutive five-minute intervals. Additionally, quantitative analyses of Poincaré plot parameters (SD1, SD2, and SD1/SD2 ratio) were performed. RESULTS In the five-minute interval before PNES, HR significantly (p<0.05) increased (d=2.5), whereas SDANN (d=-0.03) and VLF power (d=-0.05) significantly decreased. During PNES, significant increases in HF power (d=0.0006), SD1 (d=0.031), and SD2 (d=0.016) were observed. In the five-minute interval immediately following PNES, SDANN (d=0.046) and VLF power (d=0.073) significantly increased, and HR (d=-5.1) and SD1/SD2 ratio (d=-0.14) decreased, compared to the interval preceding PNES. CONCLUSION The results suggest that PNES episodes are preceded by increased sympathetic functioning, which is followed by an increase in parasympathetic functioning during and after PNES. Future research needs to identify the exact nature of the increased arousal that precedes PNES.
Collapse
Affiliation(s)
- Sylvie J M van der Kruijs
- Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands.
| | - Kristl E J Vonck
- Reference Centre for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Geert R Langereis
- University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - Loe M G Feijs
- University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - Nynke M G Bodde
- Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands
| | - Richard H C Lazeron
- Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands; Department of Neurology, Maastricht University Medical Centre, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Evelien Carrette
- Reference Centre for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Paul A J M Boon
- Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands; Reference Centre for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Walter H Backes
- School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Jacobus F A Jansen
- School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Albert P Aldenkamp
- Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands; Reference Centre for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Centre, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Pierre J M Cluitmans
- Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands; University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| |
Collapse
|
2
|
Besseling RMH, Jansen JFA, Overvliet GM, van der Kruijs SJM, Ebus SCM, de Louw AJA, Hofman PAM, Aldenkamp AP, Backes WH. Delayed convergence between brain network structure and function in rolandic epilepsy. Front Hum Neurosci 2014; 8:704. [PMID: 25249968 PMCID: PMC4158874 DOI: 10.3389/fnhum.2014.00704] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/22/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction: Rolandic epilepsy (RE) manifests during a critical phase of brain development, and has been associated with language impairments. Concordant abnormalities in structural and functional connectivity (SC and FC) have been described before. As SC and FC are under mutual influence, the current study investigates abnormalities in the SC-FC synergy in RE. Methods: Twenty-two children with RE (age, mean ± SD: 11.3 ± 2.0 y) and 22 healthy controls (age 10.5 ± 1.6 y) underwent structural, diffusion weighted, and resting-state functional magnetic resonance imaging (MRI) at 3T. The probabilistic anatomical landmarks atlas was used to parcellate the (sub)cortical gray matter. Constrained spherical deconvolution tractography and correlation of time series were used to assess SC and FC, respectively. The SC-FC correlation was assessed as a function of age for the non-zero structural connections over a range of sparsity values (0.01–0.75). A modularity analysis was performed on the mean SC network of the controls to localize potential global effects to subnetworks. SC and FC were also assessed separately using graph analysis. Results: The SC-FC correlation was significantly reduced in children with RE compared to healthy controls, especially for the youngest participants. This effect was most pronounced in a left and a right centro-temporal network, as well as in a medial parietal network. Graph analysis revealed no prominent abnormalities in SC or FC network organization. Conclusion: Since SC and FC converge during normal maturation, our finding of reduced SC-FC correlation illustrates impaired synergy between brain structure and function. More specifically, since this effect was most pronounced in the youngest participants, RE may represent a developmental disorder of delayed brain network maturation. The observed effects seem especially attributable to medial parietal connections, which forms an intermediate between bilateral centro-temporal modules of epileptiform activity, and bear relevance for language function.
Collapse
Affiliation(s)
- René M H Besseling
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Research School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Radiology, Maastricht University Medical Center Maastricht, Netherlands
| | - Jacobus F A Jansen
- Research School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Radiology, Maastricht University Medical Center Maastricht, Netherlands
| | - Geke M Overvliet
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Sylvie J M van der Kruijs
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Research School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
| | | | - Anton J A de Louw
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Paul A M Hofman
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Albert P Aldenkamp
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Walter H Backes
- Research School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Radiology, Maastricht University Medical Center Maastricht, Netherlands
| |
Collapse
|
3
|
van der Kruijs SJM, Jagannathan SR, Bodde NMG, Besseling RMH, Lazeron RHC, Vonck KEJ, Boon PAJM, Cluitmans PJM, Hofman PAM, Backes WH, Aldenkamp AP, Jansen JFA. Resting-state networks and dissociation in psychogenic non-epileptic seizures. J Psychiatr Res 2014; 54:126-33. [PMID: 24703187 DOI: 10.1016/j.jpsychires.2014.03.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/12/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Psychogenic non-epileptic seizures (PNES) are epilepsy-like episodes which have an emotional rather than organic origin. Although PNES have often been related to the process of dissociation, the psychopathology is still poorly understood. To elucidate underlying mechanisms, the current study applied independent component analysis (ICA) on resting-state fMRI to investigate alterations within four relevant networks, associated with executive, fronto-parietal, sensorimotor, and default mode activation, and within a visual network to examine specificity of between-group differences. METHODS Twenty-one patients with PNES without psychiatric or neurologic comorbidities and twenty-seven healthy controls underwent resting-state functional MR imaging at 3.0T (Philips Achieva). Additional neuropsychological testing included Raven's Matrices test and dissociation questionnaires. ICA with dual regression was used to identify resting-state networks in all participants, and spatial maps of the networks of interest were compared between patients and healthy controls. RESULTS Patients displayed higher dissociation scores, lower cognitive performance and increased contribution of the orbitofrontal, insular and subcallosal cortex in the fronto-parietal network; the cingulate and insular cortex in the executive control network; the cingulate gyrus, superior parietal lobe, pre- and postcentral gyri and supplemental motor cortex in the sensorimotor network; and the precuneus and (para-) cingulate gyri in the default-mode network. The connectivity strengths within these regions of interest significantly correlated with dissociation scores. No between-group differences were found within the visual network, which was examined to determine specificity of between-group differences. CONCLUSIONS PNES patients displayed abnormalities in several resting-state networks that provide neuronal correlates for an underlying dissociation mechanism.
Collapse
Affiliation(s)
- Sylvie J M van der Kruijs
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Departments of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sridhar R Jagannathan
- Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
| | - Nynke M G Bodde
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - René M H Besseling
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Departments of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Richard H C Lazeron
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Kristl E J Vonck
- Reference Centre for Refractory Epilepsy, Ghent University Hospital, Ghent, Belgium
| | - Paul A J M Boon
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Reference Centre for Refractory Epilepsy, Ghent University Hospital, Ghent, Belgium
| | - Pierre J M Cluitmans
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
| | - Paul A M Hofman
- Departments of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Walter H Backes
- Departments of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Albert P Aldenkamp
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands; Departments of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Reference Centre for Refractory Epilepsy, Ghent University Hospital, Ghent, Belgium
| | - Jacobus F A Jansen
- Departments of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
4
|
van der Kruijs SJM, Bodde NMG, Carrette E, Lazeron RHC, Vonck KEJ, Boon PAJM, Langereis GR, Cluitmans PJM, Feijs LMG, Hofman PAM, Backes WH, Jansen JFA, Aldenkamp AP. Neurophysiological correlates of dissociative symptoms. J Neurol Neurosurg Psychiatry 2014; 85:174-9. [PMID: 23175855 DOI: 10.1136/jnnp-2012-302905] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Dissociation is a mental process with psychological and somatoform manifestations, which is closely related to hypnotic suggestibility and essentially shows the ability to obtain distance from reality. An increased tendency to dissociate is a frequently reported characteristic of patients with functional neurological symptoms and syndromes (FNSS), which account for a substantial part of all neurological admissions. This review aims to investigate what heart rate variability (HRV), EEG and neuroimaging data (MRI) reveal about the nature of dissociation and related conditions. METHODS Studies reporting HRV, EEG and neuroimaging data related to hypnosis, dissociation and FNSS were identified by searching the electronic databases Pubmed and ScienceDirect. RESULTS The majority of the identified studies concerned the physiological characteristics of hypnosis; relatively few investigations on dissociation related FNSS were identified. General findings were increased parasympathetic functioning during hypnosis (as measured by HRV), and lower HRV in patients with FNSS. The large variety of EEG and functional MRI investigations with diverse results challenges definite conclusions, but evidence suggests that subcortical as well as (pre)frontal regions serve emotion regulation in dissociative conditions. Functional connectivity analyses suggest the presence of altered brain networks in patients with FNSS, in which limbic areas have an increased influence on motor preparatory regions. CONCLUSIONS HRV, EEG and (functional) MRI are sensitive methods to detect physiological changes related to dissociation and dissociative disorders such as FNSS, and can possibly provide more information about their aetiology. The use of such measures could eventually provide biomarkers for earlier identification of patients at risk and appropriate treatment of dissociative conditions.
Collapse
|
5
|
Besseling RMH, Jansen JFA, Overvliet GM, van der Kruijs SJM, Ebus SCM, de Louw A, Hofman PAM, Vles JSH, Aldenkamp AP, Backes WH. Reduced structural connectivity between sensorimotor and language areas in rolandic epilepsy. PLoS One 2013; 8:e83568. [PMID: 24376719 PMCID: PMC3871667 DOI: 10.1371/journal.pone.0083568] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/12/2013] [Indexed: 12/13/2022] Open
Abstract
Introduction Rolandic epilepsy (RE) is a childhood epilepsy with centrotemporal (rolandic) spikes, that is increasingly associated with language impairment. In this study, we tested for a white matter (connectivity) correlate, employing diffusion weighted MRI and language testing. Methods Twenty-three children with RE and 23 matched controls (age: 8–14 years) underwent structural (T1-weighted) and diffusion-weighted MRI (b = 1200 s/mm2, 66 gradient directions) at 3T, as well as neuropsychological language testing. Combining tractography and a cortical segmentation derived from the T1-scan, the rolandic tract were reconstructed (pre- and postcentral gyri), and tract fractional anisotropy (FA) values were compared between patients and controls. Aberrant tracts were tested for correlations with language performance. Results Several reductions of tract FA were found in patients compared to controls, mostly in the left hemisphere; the most significant effects involved the left inferior frontal (p = 0.005) and supramarginal (p = 0.004) gyrus. In the patient group, lower tract FA values were correlated with lower language performance, among others for the connection between the left postcentral and inferior frontal gyrus (p = 0.043, R = 0.43). Conclusion In RE, structural connectivity is reduced for several connections involving the rolandic regions, from which the epileptiform activity originates. Most of these aberrant tracts involve the left (typically language mediating) hemisphere, notably the pars opercularis of the inferior frontal gyrus (Broca’s area) and the supramarginal gyrus (Wernicke’s area). For the former, reduced language performance for lower tract FA was found in the patients. These findings provide a first microstructural white matter correlate for language impairment in RE.
Collapse
Affiliation(s)
- René M. H. Besseling
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jacobus F. A. Jansen
- Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Geke M. Overvliet
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sylvie J. M. van der Kruijs
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | | | - Anton de Louw
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul A. M. Hofman
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johannes S. H. Vles
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert P. Aldenkamp
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Walter H. Backes
- Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
- * E-mail:
| |
Collapse
|
6
|
Braakman HMH, van der Kruijs SJM, Vaessen MJ, Jansen JFA, Debeij-van Hall MHJA, Vles JSH, Aldenkamp AP, Backes WH, Hofman PAM. Microstructural and functional MRI studies of cognitive impairment in epilepsy. Epilepsia 2012; 53:1690-9. [PMID: 22889330 DOI: 10.1111/j.1528-1167.2012.03624.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cognitive impairment is the most common comorbidity in children with epilepsy, but its pathophysiology and predisposing conditions remain unknown. Clinical epilepsy characteristics are not conclusive in determining cognitive outcome. Because many children with epilepsy do not have macrostructural magnetic resonance imaging (MRI) abnormalities, the underlying substrate for cognitive impairment may be found at the microstructural or functional level. In the last two decades, new MRI techniques have been developed that have the potential to visualize microstructural or functional abnormalities associated with cognitive impairment. These include volumetric MRI, voxel-based morphometry (VBM), diffusion tensor imaging (DTI), MR spectroscopy (MRS), and functional MRI (fMRI). All of these techniques have shed new light on various aspects associated with, or underlying, cognitive impairment, although their use in epilepsy has been limited and focused mostly on adults. Therefore, in this review, the use of all these different MRI techniques to unravel cognitive impairment in epilepsy is discussed both in adults and children with epilepsy. Volumetric MRI and VBM have revealed significant volume losses in the area of the seizure focus as well as in distant areas. DTI adds evidence of loss of integrity of connections from the seizure focus to distant areas as well as between distant areas. MRS and fMRI have shown impaired function both in the area of the seizure focus as well as in distant structures. For this review we have compiled and compared findings from the various techniques to conclude that cognitive impairment in epilepsy results from a network disorder in which the (micro)structures as well as the functionality can be disturbed.
Collapse
Affiliation(s)
- Hilde M H Braakman
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
van der Kruijs SJM, Bodde NMG, Vaessen MJ, Lazeron RHC, Vonck K, Boon P, Hofman PAM, Backes WH, Aldenkamp AP, Jansen JFA. Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. J Neurol Neurosurg Psychiatry 2012; 83:239-47. [PMID: 22056967 DOI: 10.1136/jnnp-2011-300776] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures, but lack epileptiform brain activity. Instead, the cause is assumed to be psychogenic. An abnormal coping strategy may be exhibited by PNES patients, as indicated by their increased tendency to dissociate. Investigation of resting-state networks may reveal altered routes of information and emotion processing in PNES patients. The authors therefore investigated whether PNES patients differ from healthy controls in their resting-state functional connectivity characteristics and whether these connections are associated with the tendency to dissociate. METHODS 11 PNES patients without psychiatric comorbidity and 12 healthy controls underwent task-related paradigms (picture-encoding and Stroop paradigms) and resting-state functional MRI (rsfMRI). Global cognitive performance was tested using the Raven's Matrices test and participants completed questionnaires for evaluating dissociation. Functional connectivity analysis on rsfMRI was based on seed regions extracted from task-related fMRI activation maps. RESULTS The patients displayed a significantly lower cognitive performance and significantly higher dissociation scores. No significant differences were found between the picture-encoding and Stroop colour-naming activation maps between controls and patients with PNES. However, functional connectivity maps from the rsfMRI were statistically different. For PNES patients, stronger connectivity values between areas involved in emotion (insula), executive control (inferior frontal gyrus and parietal cortex) and movement (precentral sulcus) were observed, which were significantly associated with dissociation scores. CONCLUSION The abnormal, strong functional connectivity in PNES patients provides a neurophysiological correlate for the underlying psychoform and somatoform dissociation mechanism where emotion can influence executive control, resulting in altered motor function (eg, seizure-like episodes).
Collapse
|