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Silva NA, Barrios-Martinez J, Yeh FC, Hodaie M, Roque D, Boerwinkle VL, Krishna V. Diffusion and functional MRI in surgical neuromodulation. Neurotherapeutics 2024; 21:e00364. [PMID: 38669936 PMCID: PMC11064589 DOI: 10.1016/j.neurot.2024.e00364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Surgical neuromodulation has witnessed significant progress in recent decades. Notably, deep brain stimulation (DBS), delivered precisely within therapeutic targets, has revolutionized the treatment of medication-refractory movement disorders and is now expanding for refractory psychiatric disorders, refractory epilepsy, and post-stroke motor recovery. In parallel, the advent of incisionless treatment with focused ultrasound ablation (FUSA) can offer patients life-changing symptomatic relief. Recent research has underscored the potential to further optimize DBS and FUSA outcomes by conceptualizing the therapeutic targets as critical nodes embedded within specific brain networks instead of strictly anatomical structures. This paradigm shift was facilitated by integrating two imaging modalities used regularly in brain connectomics research: diffusion MRI (dMRI) and functional MRI (fMRI). These advanced imaging techniques have helped optimize the targeting and programming techniques of surgical neuromodulation, all while holding immense promise for investigations into treating other neurological and psychiatric conditions. This review aims to provide a fundamental background of advanced imaging for clinicians and scientists, exploring the synergy between current and future approaches to neuromodulation as they relate to dMRI and fMRI capabilities. Focused research in this area is required to optimize existing, functional neurosurgical treatments while serving to build an investigative infrastructure to unlock novel targets to alleviate the burden of other neurological and psychiatric disorders.
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Affiliation(s)
- Nicole A Silva
- Department of Neurological Surgery, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mojgan Hodaie
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Daniel Roque
- Department of Neurology, University of North Carolina in Chapel Hill, NC, USA
| | - Varina L Boerwinkle
- Department of Neurology, University of North Carolina in Chapel Hill, NC, USA
| | - Vibhor Krishna
- Department of Neurological Surgery, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
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Lewis EC, Jaeger A, Girn M, Omene E, Brendle M, Argento E. Exploring psychedelic-assisted therapy in the treatment of functional seizures: A review of underlying mechanisms and associated brain networks. J Psychopharmacol 2024:2698811241248395. [PMID: 38654554 DOI: 10.1177/02698811241248395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/26/2024]
Abstract
Functional seizures (FS), the most common subtype of functional neurological disorder (FND), cause serious neurological disability and significantly impact quality of life. Characterized by episodic disturbances of functioning that resemble epileptic seizures, FS coincide with multiple comorbidities and are treated poorly by existing approaches. Novel treatment approaches are sorely needed. Notably, mounting evidence supports the safety and efficacy of psychedelic-assisted therapy (PAT) for several psychiatric conditions, motivating investigations into whether this efficacy also extends to neurological disorders. Here, we synthesize past empirical findings and frameworks to construct a biopsychosocial mechanistic argument for the potential of PAT as a treatment for FS. In doing so, we highlight FS as a well-defined cohort to further understand the large-scale neural mechanisms underpinning PAT. Our synthesis is guided by a complexity science perspective which we contend can afford unique mechanistic insight into both FS and PAT, as well as help bridge these two domains. We also leverage this perspective to propose a novel analytic roadmap to identify markers of FS diagnostic specificity and treatment success. This endeavor continues the effort to bridge clinical neurology with psychedelic medicine and helps pave the way for a new field of psychedelic neurology.
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Affiliation(s)
- Evan Cole Lewis
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Manesh Girn
- Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Madeline Brendle
- Numinus Wellness Inc., Vancouver, BC, Canada
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Elena Argento
- Numinus Wellness Inc., Vancouver, BC, Canada
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
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Hassan J, Taib S, Yrondi A. Structural and functional changes associated with functional/dissociative seizures: A review of the literature. Epilepsy Behav 2024; 152:109654. [PMID: 38281393 DOI: 10.1016/j.yebeh.2024.109654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The term 'functional/dissociative seizures (FDS)' refers to a paroxysmal, transient clinical manifestation that may include motor, sensory, vegetative, psychological and cognitive signs, similar to the manifestations observed in epileptic seizures. In recent years, there has been an increase of literature in the field of brain imaging research on functional neurological disorders and, more specifically, on FDS. However, most of the studies have been carried out on limited samples. We propose an update of this review work by performing a systematic review of studies performed since 2017 in the field of neuroimaging in patients with FDS. METHODS We conducted a systematic review of the literature using the PRISMA methodology and reproduced most of the methodological elements of the latest systematic literature review. RESULTS Our work over the last five years has identified 14 articles. It is still difficult to isolate a distinct structure or network specifically involved in the mechanism of FDS. However, certain structures are recurrently involved in imaging studies, notably the amygdala, the orbitofrontal cortex, and the anterior cingulate cortex. CONCLUSION The contribution of neuroimaging may allow a more precise explanation of the disorder for patients, avoiding the stigma frequently associated with this diagnosis. as with other 'conversion' phenomena which have traditionally been considered only as 'medically unexplained'. In the longer term and beyond a better understanding of the physiopathology of the disorder, the challenge of this neuroimaging work would be to identify specific imaging biomarkers for a diagnosis of FDS.
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Affiliation(s)
- Johann Hassan
- Service de Psychiatrie et de Psychologie Médicale (Department of Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Simon Taib
- Service de Psychiatrie, Psychothérapie et Art thérapie CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale (Department of Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France.
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Fox J, Bollig MK, Mishra M, Jacobs M. Neuropsychological characteristics of drug resistant epilepsy patients with and without comorbid functional seizures. Epilepsy Res 2024; 201:107340. [PMID: 38442550 DOI: 10.1016/j.eplepsyres.2024.107340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Neuropsychological testing is a mandatory component in the evaluation of drug resistant epilepsy. The results of testing may assist with both the localization of an epilepsy as well as assessment of surgical risk. Previous studies have demonstrated differences in the neuropsychological performance of patients with epilepsy and functional seizures. We hypothesized that comorbid functional seizures could potentially influence neuropsychological test performance. Therefore, we evaluated whether there is a difference in the neuropsychological test results between drug resistant epilepsy patients with and without comorbid functional seizures. METHOD Neuropsychological test results were compared between 25 patients with drug resistant focal epilepsy and 25 patients that also had documented functional seizures. Univariate analyses and multiple logistic regression models were used to both assess performance differences between the groups and to assess whether test results could be used to accurately identify which patients had comorbid functional seizures. RESULTS Epilepsy patients with comorbid functional seizures performed significantly worse on the FAS Verbal Fluency Test compared to ES patients (p = 0.047). Digit Span Backwards (p = 0.10), Digit Span Forwards (p = 0.14) and Working Memory Index (p = 0.10) tended to be lower in the epilepsy and functional seizures group but was not statistically significant. A multiple logistic regression model using the results of four neuropsychological tests was able to identify patients with comorbid functional seizures with 83.33% accuracy. CONCLUSIONS There are appeared to be some differences in the neuropsychological performance among drug resistant epilepsy patients based on whether they have comorbid functional seizures. These findings may have relevant implications for the interpretation of neuropsychological test results.
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Affiliation(s)
- Jonah Fox
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Madelyn K Bollig
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Murli Mishra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Monica Jacobs
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
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Ota M, Sone D, Shigemoto Y, Kimura Y, Matsuda H, Sato N. Glymphatic System Activity and Brain Morphology in Patients With Psychogenic Non-epileptic Seizures. Cureus 2024; 16:e53072. [PMID: 38410305 PMCID: PMC10896675 DOI: 10.7759/cureus.53072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND To clarify the neural correlates underlying psychogenic non-epileptic seizures (PNES), we compared glymphatic system activity between patients with PNES and healthy participants using diffusion tensor imaging (DTI)-analysis along the perivascular space (ALPS) method. METHODS The DTI scans were acquired from 16 patients with PNES and 25 healthy participants. We computed the DTI-ALPS index as an index of glymphatic system function and estimated the disease-related changes in the DTI-ALPS index and brain structures in PNES patients. RESULTS There were no significant differences in the DTI-ALPS index between patients with PNES and healthy participants. On the other hand, patients with PNES had decreased fractional anisotropy values in the bilateral posterior cingula, a higher mean diffusivity value around the left insula, and a lower gray matter volume in the bilateral amygdalae compared with healthy participants. CONCLUSIONS Patients with PNES exhibited an impairment of white matter integrity and a reduction of gray matter volume, but no glymphatic-system changes. These findings will play a significant role in our comprehension of this complex illness.
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Affiliation(s)
- Miho Ota
- Neuropsychiatry, University of Tsukuba, Tsukuba, JPN
| | - Daichi Sone
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| | - Yoko Shigemoto
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| | - Yukio Kimura
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| | - Hiroshi Matsuda
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| | - Noriko Sato
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
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Boerwinkle VL, Gillette K, Rubinos CA, Broman-Fulks J, Aseem F, DeHoff GK, Arhin M, Cediel E, Strohm T. Functional MRI for Acute Covert Consciousness: Emerging Data and Implementation Case Series. Semin Neurol 2023; 43:712-734. [PMID: 37788679 DOI: 10.1055/s-0043-1775845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Although research studies have begun to demonstrate relationships between disorders of consciousness and brain network biomarkers, there are limited data on the practical aspects of obtaining such network biomarkers to potentially guide care. As the state of knowledge continues to evolve, guidelines from professional societies such as the American and European Academies of Neurology and many experts have advocated that the risk-benefit ratio for the assessment of network biomarkers has begun to favor their application toward potentially detecting covert consciousness. Given the lack of detailed operationalization guidance and the context of the ethical implications, herein we offer a roadmap based on local institutional experience with the implementation of functional MRI in the neonatal, pediatric, and adult intensive care units of our local government-supported health system. We provide a case-based demonstrative approach intended to review the current literature and to assist with the initiation of such services at other facilities.
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Affiliation(s)
- Varina L Boerwinkle
- Division of Child Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kirsten Gillette
- Division of Child Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Clio A Rubinos
- Division of Neurocritical Care, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jordan Broman-Fulks
- Division of Child Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Fazila Aseem
- Division of Neurocritical Care, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Grace K DeHoff
- Division of Neurocritical Care, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Martin Arhin
- Division of Child Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Emilio Cediel
- Division of Child Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Tamara Strohm
- Division of Neurocritical Care, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Sone D. White Matter Structural Connectivity and Its Impact on Psychogenic Non-Epileptic Seizures: An Evidence-Based Review. Neuropsychiatr Dis Treat 2023; 19:1573-1579. [PMID: 37457838 PMCID: PMC10349606 DOI: 10.2147/ndt.s402378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
Psychiatric non-epileptic seizure (PNES), also known as a form of functional neurological disorders (FND), is a common but still underrecognized disorder presenting seizure-like symptoms and no electrophysiological abnormality. Despite the significant burden of this disorder, the neurobiological mechanisms are not clearly understood, which hinders the development of better diagnosis and treatment. In the recent neuroimaging research on PNES, brain network analysis has become a relevant topic beyond conventional methodologies. The human brain is a highly intricate system of interconnected regions that collaborate to facilitate a wide range of cognitive and behavioral functions. White matter tracts, which are comprised of bundles of axonal fibers, are the primary means by which information is transmitted between different brain regions. As such, comprehending the organization and structure of the brain's white matter network is critical for gaining insight into its functional architecture. This review article aims to provide an overview of the brain mechanisms underlying PNES, with a special focus on analyzing brain networks.
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Affiliation(s)
- Daichi Sone
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
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Cassady M, Baslet G. Dissociation in patients with epilepsy and functional seizures: A narrative review of the literature. Seizure 2023; 110:220-230. [PMID: 37433243 DOI: 10.1016/j.seizure.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023] Open
Abstract
Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
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Affiliation(s)
- Maureen Cassady
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Tsalouchidou PE, Mross PM, Gorny I, Belke M, Habermehl L, Schulze M, Zahnert F, Kraeling G, Fuest S, Menzler K, Knake S. Morphometric correlates in patients with functional seizures with and without comorbid epilepsy. Acta Neurol Belg 2023. [PMID: 36749466 DOI: 10.1007/s13760-023-02208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Functional seizures (FS) or psychogenic, non-epileptic seizures (PNES) are episodic alterations of behaviour with similar semiology to epileptic seizures but which are not caused by epileptic brain activity. Epilepsy patients show a high risk in developing FS; therefore, the purpose of this study is to examine morphometric correlates in patients with FS as well as in epilepsy patients with FS by comparing them separately to healthy controls (HC). METHODS Twenty-one clinical three-dimensional (3D) T1-magnetic resonance imaging (MRI) scans of patients with FS (FS group) and 15 patients with FS and epilepsy (EFS group) were retrospectively compared with one control group of 21 age- and gender-matched HC. Two separate general linear model analyses were conducted via FreeSurfer version 6.0. RESULTS The study population consisted of 21 FS patients (66.7% females, n = 14) with a median age at the time of the scan of 24 years (range 17-44 years); 15 EFS patients (80% females, n = 12) with a median age at the time of the scan of 27 years (range 16-43 years); and 21 healthy subjects (66.7% females, n = 14) with a median age at the time of the scan of 24 years (range 19-38 years). Both patient groups showed an increased Cth in the right prefrontal lobe: in the FS group in the right superior frontal, rostral middle frontal gyri and the right orbitofrontal cortex and, in the EFS group, in the right superior frontal gyrus and the right orbitofrontal cortex. Decreases in Cth were present in the right lateral occipital lobe in the FS group, while also in both hemispheres in the EFS group, namely the left paracentral, superior frontal, caudal middle frontal, lateral occipital and right superior frontal gyri. Neither group showed changes in curvature. CONCLUSION These results suggest alterations in regions of emotional processing and executive control in patients with FS regardless of the presence of epilepsy.
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Leroy A, Tarrada A, Garcin B, Hingray C. Crisi psicogene non epilettiche (funzionali/dissociative). Neurologia 2023. [DOI: 10.1016/s1634-7072(22)47362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Asadi-Pooya AA, Kerr WT, Karakis I, Kanemoto K, Daza-Restrepo A, Farazdaghi M, Horbatch FJ, Beimer NJ, Eliashiv DE, Risman A, Sugimoto Y, Giagante B. Are brain MRI abnormalities associated with the semiology of functional seizures? Brain Behav 2023; 13:e2882. [PMID: 36624686 PMCID: PMC9927836 DOI: 10.1002/brb3.2882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/17/2022] [Revised: 11/06/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To investigate whether radiologically apparent brain magnetic resonance imaging (MRI) abnormalities are associated with the functional seizure (FS) semiology. METHODS All patients with a diagnosis of FS at the epilepsy centers at Shiraz University of Medical Sciences, Iran; Aichi Medical University Hospital, Japan; University of Michigan, USA; University of California, Los Angeles, USA; Emory University School of Medicine, USA; and Hospital el Cruce, Argentina, were studied. RESULTS One hundred patients were included; 77 (77%) had motor functional seizures. Lobar location of brain abnormality did not have an association with the semiology (p = .83). There was no significant difference between ictal behaviors in patients with frontal or parietal lesions compared to those with temporal or occipital lesions. CONCLUSION There were no associations between functional seizure ictal behaviors and locations of the radiologically apparent brain MRI abnormalities. Further studies are needed to evaluate the underpinnings of varying behaviors in FS.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Wesley T Kerr
- Department of Neurology, University of Michigan, Ann Arbor, Michigan.,Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Kousuke Kanemoto
- Neuropsychiatric Department, Aichi Medical University, Nagakute, Aichi, Japan
| | - Anilu Daza-Restrepo
- ENyS CONICET - Neuroscience and Epilepsy Service, El Cruce Hospital "Dr. Néstor Kirchner,", Buenos Aires, Argentina
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faith J Horbatch
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Nicholas J Beimer
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Dawn E Eliashiv
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Aida Risman
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Yuko Sugimoto
- Neuropsychiatric Department, Aichi Medical University, Nagakute, Aichi, Japan
| | - Brenda Giagante
- ENyS CONICET - Neuroscience and Epilepsy Service, El Cruce Hospital "Dr. Néstor Kirchner,", Buenos Aires, Argentina
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Muacevic A, Adler JR. Structural Changes in Brain Magnetic Resonance Imaging Associated With Psychogenic Non-epileptic Seizures: An Analytical Cross-Sectional Study. Cureus 2022; 14:e32144. [PMID: 36601196 PMCID: PMC9806188 DOI: 10.7759/cureus.32144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background Psychogenic non-epileptic seizures (PNES) are often seen as indicators of poor motor and sensory function caused by psychological responses to stressful experiences. A seizure might trigger these reactions. The aim of our study was to assess the structural changes in brain MRI associated with psychogenic non-epileptic seizures. Methodology A retrospective analytical cross-sectional study at the Department of Medicine and Neurology, Ayub Teaching Hospital, Abbottabad, was conducted from October 2020 to September 2021. The medical records of patients with confirmed PNES were collected and retrospectively evaluated. Results Medical records and MRI scans were accessible for 52 patients with PNES; 10 patients were excluded from the study. The average age of the patients (standard deviation) was 34 (±9) years, and the average age at onset was 31.6 (±5.8) years. Based on the video-EEG recordings, 57.1% of patients (n=24) were classified as having broadly generalized motor seizures, 40% of patients (n=17) were classified as having predominantly akinetic seizures defined primarily by blank spells, and only one patient was classified as having focal motor seizures. Only three patients (7%) had a positive epilepsy family history. Twenty-four (47.6%) patients with brain MRI scans reported abnormal findings, while 22 (52.4%) had normal MRI findings. The majority of patients with abnormal MRIs had nonspecific white matter changes (50%), mesial temporal sclerosis (15%), and cysts (15%). In a statistical analysis, age at the beginning of PNES (p = 0.04), duration of PNES (p=0.01), concomitant epilepsy (p = 0.05), generalized motor seizures (p= 0.03), and focal motor seizures (p= 0.02) were strongly associated with abnormal brain MRI findings. Conclusion Research reveals that persons with PNES have a higher-than-average prevalence of anatomical brain abnormalities. The main takeaway is that these findings lend credence to the growing body of data suggesting that PNES may not be a medical mystery but rather a disorder with physical foundations in the brain. Important implications for diagnosing and treating PNES patients are discussed, as are the outcomes of earlier neuroimaging investigations of PNES. Studying the involvement of structural brain anomalies in the etiology of psychogenic non-epileptic seizures requires further well-designed multicenter studies with larger sample sizes and a consistent imaging approach (PNES). It is crucial to consider any confounding variables, such as co-occurring mental diseases, while designing this study.
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Jungilligens J, Popkirov S, Perez DL, Diez I. Linking gene expression patterns and brain morphometry to trauma and symptom severity in patients with functional seizures. Psychiatry Res Neuroimaging 2022; 326:111533. [PMID: 36055038 PMCID: PMC9968826 DOI: 10.1016/j.pscychresns.2022.111533] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/05/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
Within stress-diathesis models, adverse life experiences (ALEs) increase the susceptibility to functional neurological symptoms through neuroplasticity effects. We aimed to characterize potential genetic influences on this relationship in 20 patients with functional seizures. Questionnaires, structural MRIs and Allen Human Brain Atlas gene expression information were used to probe the intersection of symptom severity (Somatoform Dissociation Questionnaire, SDQ-20), ALE burden, and gray matter volumes. SDQ-20 scores positively correlated with sexual trauma, emotional neglect, and threat to life experiences. Higher SDQ-20 scores related to lower bilateral insula, left orbitofrontal, right amygdala, and perigenual/posterior cingulate volumes. Higher sexual trauma burden correlated with lower right posterior insula and putamen volumes; higher emotional neglect related to lower bilateral insula/right amygdala volumes. Findings in left insula/ventral precentral gyrus (SDQ-20), right insula/putamen (sexual trauma), and right amygdala (emotional neglect) held when controlling for comorbid psychopathology. At the intersection of symptom severity and sexual trauma volumetric findings, genes overrepresented in adrenergic, serotonergic, and oxytocin receptor signaling as well as in cortical and amygdala development were spatially correlated. In conclusion, ALEs and symptom severity were associated with gray matter volumes in cingulo-insular and amygdala areas, spatially overlapping with expression patterns of genes involved in stress-related signaling and neurodevelopment.
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Affiliation(s)
- Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany; Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Ibai Diez
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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14
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Kerr WT, Tatekawa H, Lee JK, Karimi AH, Sreenivasan SS, O'Neill J, Smith JM, Hickman LB, Savic I, Nasrullah N, Espinoza R, Narr K, Salamon N, Beimer NJ, Hadjiiski LM, Eliashiv DS, Stacey WC, Engel J, Feusner JD, Stern JM. Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls. Epilepsy Behav 2022; 134:108858. [PMID: 35933959 DOI: 10.1016/j.yebeh.2022.108858] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/03/2022] [Revised: 06/26/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Functional seizures (FS), also known as psychogenic nonepileptic seizures (PNES), are physical manifestations of acute or chronic psychological distress. Functional and structural neuroimaging have identified objective signs of this disorder. We evaluated whether magnetic resonance imaging (MRI) morphometry differed between patients with FS and clinically relevant comparison populations. METHODS Quality-screened clinical-grade MRIs were acquired from 666 patients from 2006 to 2020. Morphometric features were quantified with FreeSurfer v6. Mixed-effects linear regression compared the volume, thickness, and surface area within 201 regions-of-interest for 90 patients with FS, compared to seizure-naïve patients with depression (n = 243), anxiety (n = 68), and obsessive-compulsive disorder (OCD, n = 41), respectively, and to other seizure-naïve controls with similar quality MRIs, accounting for the influence of multiple confounds including depression and anxiety based on chart review. These comparison populations were obtained through review of clinical records plus research studies obtained on similar scanners. RESULTS After Bonferroni-Holm correction, patients with FS compared with seizure-naïve controls exhibited thinner bilateral superior temporal cortex (left 0.053 mm, p = 0.014; right 0.071 mm, p = 0.00006), thicker left lateral occipital cortex (0.052 mm, p = 0.0035), and greater left cerebellar white-matter volume (1085 mm3, p = 0.0065). These findings were not accounted for by lower MRI quality in patients with FS. CONCLUSIONS These results reinforce prior indications of structural neuroimaging correlates of FS and, in particular, distinguish brain morphology in FS from that in depression, anxiety, and OCD. Future work may entail comparisons with other psychiatric disorders including bipolar and schizophrenia, as well as exploration of brain structural heterogeneity within FS.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Hiroyuki Tatekawa
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John K Lee
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Siddhika S Sreenivasan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Jena M Smith
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Brian Hickman
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ivanka Savic
- Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Nilab Nasrullah
- Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nicholas J Beimer
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lubomir M Hadjiiski
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dawn S Eliashiv
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William C Stacey
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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15
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Szaflarski JP, Allendorfer JB, Goodman AM, Byington CG, Philip NS, Correia S, LaFrance WC. Diagnostic delay in functional seizures is associated with abnormal processing of facial emotions. Epilepsy Behav 2022; 131:108712. [PMID: 35526462 DOI: 10.1016/j.yebeh.2022.108712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/08/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In patients with functional seizures (FS), delay in diagnosis (DD) may negatively affect outcomes. Altered brain responses to emotional stimuli have been shown in adults with FS. We hypothesized that DD would be associated with differential fMRI activation in emotion processing circuits. METHODS Fifty-two adults (38 females) with video-EEG confirmed FS prospectively completed assessments related to symptoms of depression (BDI-II), anxiety (BAI), post-traumatic stress disorder (PCL-S), a measure of how their symptoms affect day-to-day life (GAF), and fMRI at 3T with emotional faces task (EFT). During fMRI, subjects indicated "male" or "female" via button press while implicitly processing happy, sad, fearful, and neutral faces. Functional magnetic resonance imaging (FMRI) response to each emotion was modeled and group analyses were performed in AFNI within pre-specified regions-of-interest involved in emotion processing. A median split (507 days) defined short- (s-DD) and long-delay diagnosis (l-DD) groups. Voxelwise regression analyses were also performed to examine linear relationship between DD and emotion processing. FMRI signal was extracted from clusters showing group differences and Spearman's correlations assessed relationships with symptom scores. RESULTS Groups did not differ in FS age of onset, sex distribution, years of education, TBI characteristics, EFT in-scanner or post-test performance, or scores on the GAF, BDI-II, BAI, and PCL-S measures. The s-DD group was younger than l-DD (mean age 32.6 vs. 40.1; p = 0.022) at the time of study participation. After correcting for age, compared to s-DD, the l-DD group showed greater fMRI activation to sad faces in the bilateral posterior cingulate cortex (PCC) and to neutral faces in the right anterior insula. Within-group linear regression revealed that with increasing DD, there was increased fMRI activation to sad faces in the PCC and to happy faces in the right anterior insula/inferior frontal gyrus (AI/IFG). There were positive correlations between PCC response to sad faces and BDI-II scores in the l-DD group (rho = 0.48, p = 0.012) and the combined sample (rho = 0.30, p = 0.029). Increased PCC activation to sad faces in those in the l-DD group was associated with worse symptoms of depression (i.e. higher BDI-II score). CONCLUSIONS Delay in FS diagnosis is associated with fMRI changes in PCC and AI/IFG. As part of the default mode network, PCC is implicated in mood control, self-referencing, and other emotion-relevant processes. In our study, PCC changes are linked to depression. Future studies should assess the effects of interventions on these abnormalities.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Adam M Goodman
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Caroline G Byington
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Noah S Philip
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephen Correia
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
| | - W Curt LaFrance
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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16
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Nisticò V, Rossi RE, D'Arrigo AM, Priori A, Gambini O, Demartini B. Functional neuroimaging in Irritable Bowel Syndrome: a systematic review highlights common brain alterations with Functional Movement Disorders. J Neurogastroenterol Motil 2022; 28:185-203. [PMID: 35189600 PMCID: PMC8978134 DOI: 10.5056/jnm21079] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/03/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by recurring abdominal pain and altered bowel habits without detectable organic causes. This study aims to provide a comprehensive overview of the literature on functional neuroimaging in IBS and to highlight brain alterations similarities with other functional disorders - functional movement disorders in particular. We conducted the bibliographic search via PubMed in August 2020 and included 50 studies following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for systematic reviews. Overall, our findings showed an aberrant activation and functional connectivity of the insular, cingulate, sensorimotor and frontal cortices, the amygdala and the hippocampus, suggesting an altered activity of the homeostatic and salience network and of the autonomous nervous system. Moreover, glutamatergic dysfunction in the anterior insula and hypothalamic pituitary axis dysregulation were often reported. These alterations seem to be very similar to those observed in patients with functional movement disorders. Hence, we speculate that different functional disturbances might share a common pathophysiology and we discussed our findings in the light of a Bayesian model framework.
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Affiliation(s)
- Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.,Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Roberta E Rossi
- Gastro-intestinal Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Pathophysiology and Organ Transplant, Università degli Studi di Milano, Milan, Italy
| | - Andrea M D'Arrigo
- Department of Neurology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Alberto Priori
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.,III Clinica Neurologica, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.,Unità di Psichiatria 52, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy
| | - Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.,Unità di Psichiatria 52, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy
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17
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Goodman AM, Allendorfer JB, LaFrance WC, Szaflarski JP. Precentral gyrus and insula responses to stress vary with duration to diagnosis in functional seizures. Epilepsia 2022; 63:865-879. [PMID: 35112346 DOI: 10.1111/epi.17179] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study was undertaken to determine whether undiagnosed illness duration (time between functional seizures [FS] onset and diagnosis) is linked to differences in neural response and functional connectivity during processing of stressful experiences. METHODS Forty-nine participants with traumatic brain injury preceding the onset of FS confirmed by video-electroencephalography were recruited prospectively. Participants completed psychiatric symptom assessments before undergoing functional magnetic resonance imaging (fMRI) with an acute psychosocial stress task. Linear mixed effects (LME) analyses identified significant interactions between the factors of group (early vs. delayed diagnosis) and time lag to diagnosis on neural responses to stressful math performance and auditory feedback (corrected α = .05). Functional connectivity analysis utilized clusters from initial LME analyses as seed regions to determine significant interactions between these factors on network functional connectivity. RESULTS Demographic and psychiatric symptom measures were similar between early (n = 25) and delayed (n = 24) groups. Responses to stressful math performance within the left anterior insula and functional connectivity between the anterior insula seed region and a precentral gyrus cluster were significantly negatively correlated with time lag to diagnosis for the early but not the delayed FS diagnosis group. There was no correlation between fMRI findings and psychiatric symptoms. SIGNIFICANCE This study indicates that aberrant left anterior insula activation and its functional connectivity to the precentral gyrus underlie differences in processing of stressful experiences in patients with delayed FS diagnosis. Follow-up comparisons suggest changes are associated with undiagnosed illness duration rather than psychiatric comorbidities and indicate a potential mechanistic association between neuropathophysiology, response to stressful experiences, and functional neuroanatomy in FS.
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Affiliation(s)
- Adam M Goodman
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - W Curt LaFrance
- Providence Veterans Affairs Medical Center, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
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18
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Ertan D, Aybek S, LaFrance WC, Kanemoto K, Tarrada A, Maillard L, El-Hage W, Hingray C. Functional (psychogenic non-epileptic/dissociative) seizures: why and how? J Neurol Neurosurg Psychiatry 2022; 93:144-157. [PMID: 34824146 DOI: 10.1136/jnnp-2021-326708] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 04/02/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Abstract
Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizures, present with ictal semiological manifestations, along with various comorbid neurological and psychological disorders. Terminology inconsistencies and discrepancies in nomenclatures of FS may reflect limitations in understanding the neuropsychiatric intricacies of this disorder. Psychological and neurobiological processes of FS are incompletely understood. Nevertheless, important advances have been made on underlying neuropsychopathophysiological mechanisms of FS. These advances provide valuable information about the underlying mechanisms of mind-body interactions. From this perspective, this narrative review summarises recent studies about aetiopathogenesis of FS at two levels: possible risk factors (why) and different aetiopathogenic models of FS (how). We divided possible risk factors for FS into three categories, namely neurobiological, psychological and cognitive risk factors. We also presented different models of FS based on psychological and neuroanatomical understanding, multilevel models and integrative understanding of FS. This work should help professionals to better understand current views on the multifactorial mechanisms involved in the development of FS. Shedding light on the different FS profiles in terms of aetiopathogenesis will help guide how best to direct therapy, based on these different underlying mechanisms.
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Affiliation(s)
- Deniz Ertan
- CRAN,UMR7039, Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, Grand Est, France.,Unité de recherche clinique, Établissement Médical de La Teppe, Tain-l'Hermitage, France
| | - Selma Aybek
- Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland.,Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland
| | - W Curt LaFrance
- Psychiatry and Neurology, Brown Medical School Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kousuke Kanemoto
- Neuropsychiatric Department, Aichi Medical University, Nagakute, Aichi, Japan
| | - Alexis Tarrada
- Neurology Department, CHRU de Nancy, Nancy, Lorraine, France.,University Psychiatry Department, Centre Psychothérapique de Nancy, Laxou, Lorraine, France
| | - Louis Maillard
- CRAN,UMR7039, Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, Grand Est, France.,Neurology Department, CHRU de Nancy, Nancy, Lorraine, France
| | - Wissam El-Hage
- Department of Psychiatry, CHRU Tours, Tours, Centre, France
| | - Coraline Hingray
- Neurology Department, CHRU de Nancy, Nancy, Lorraine, France .,University Psychiatry Department, Centre Psychothérapique de Nancy, Laxou, Lorraine, France
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19
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Fauvé P, Tyvaert L, Husson C, Hologne E, Gao X, Maillard L, Schwan R, Banasiak C, El–Hage W, Hossu G, Hingray C. Functional MRI-based study of emotional experience in patients with psychogenic non-epileptic seizures: Protocol for an observational case-control study–EMOCRISES study. PLoS One 2022; 17:e0262216. [PMID: 34995332 PMCID: PMC8741035 DOI: 10.1371/journal.pone.0262216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background
Psychogenic non epileptic seizures (PNES) are a frequent, disabling and costly disorder for which there is no consensual caring. They are considered as a dissociative disorder and they share many common characteristics with post-traumatic stress disorder (PTSD). Nevertheless, their pathophysiology is still unclear. In this study, we plan to obtain new data comparing functional brain activity of participants suffering from PNES, from PTSD and healthy controls via functional brain MRI during resting state and under emotional visual stimulation. The protocol presented hereunder describes an observational study with no direct treatment implication. Nevertheless, it could lead to a better understanding of PNES and to identifying targets for specialised cares of post-traumatic or dissociative disorders, like repetitive transcranial magnetic stimulation.
Methods & analysis
This is a prospective, single-centre, interventional, non-randomized, open, controlled and exploratory clinical study. It will involve 75 adult French, right-handed women in 3 groups, either suffering from PNES or PTSD, or healthy controls. An informed consent will be signed by each participant. All of them will be given psychiatric tests to assess dissociation and alexithymia, psychopathological profile and history, and emotional recognition. Each participant will undergo a functional brain MRI. We will record anatomical images and five functional imaging sequences including emotional periodic oscillatory stimulation, standard emotional stimulation, Go / No Go task under emotional stimulation, and resting state. Analysis will include a descriptive analysis of all participants and the treatment for functional magnetic resonance imaging images of each sequence.
Registration, ethics & dissemination
This study was approved the regional Protection of Persons Committee under the reference 16.10.01 and by the French National Medical Security Agency under the reference 2016-A01295-46. The protocol and results will be published in peer-reviewed academic medical journals and disseminated to research teams, databases, specialised media and concerned patients’ organisations.
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Affiliation(s)
- Pierre Fauvé
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Louise Tyvaert
- Faculté de Médecine de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
- Centre de Recherche en Automatique de Nancy, U7039, Centre National de la Recherche Scientifique et Université de Lorraine, Nancy, France
| | - Cyril Husson
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Emmanuelle Hologne
- Faculté de Médecine de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Xiaoqing Gao
- Center for Psychological Sciences, Zhejiang University, Hangzhou, China
| | - Louis Maillard
- Faculté de Médecine de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
- Centre de Recherche en Automatique de Nancy, U7039, Centre National de la Recherche Scientifique et Université de Lorraine, Nancy, France
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- Faculté de Médecine de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Claire Banasiak
- Centre d’Investigation Clinique–Innovation Technologique, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Wissam El–Hage
- iBrain, U1253, Institut National de la Santé et de la Recherche Médicale et Université de Tours, Tours, France
- Clinique Psychiatrique Universitaire, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Gabriela Hossu
- Centre d’Investigation Clinique–Innovation Technologique, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
- IADI, U1254, Institut National de la Santé et de la Recherche Médicale et Université de Lorraine, Nancy, France
| | - Coraline Hingray
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
- * E-mail:
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20
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Sharma AA, Szaflarski JP. Neuroinflammation as a pathophysiological factor in the development and maintenance of functional seizures: A hypothesis. Epilepsy Behav Rep 2021; 16:100496. [PMID: 34917920 PMCID: PMC8645839 DOI: 10.1016/j.ebr.2021.100496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/03/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022] Open
Abstract
Early-life stress may be a priming neuroinflammatory factor for later development of FS. Secondary trauma has emerged as an important predisposing factor for FS initiation. We propose an explanatory, two-hit hypothesis for FS development. The proposed hypothesis is based on findings from neuroimaging and biomarker studies.
The neurobiological underpinnings of functional seizure (FS) development and maintenance represent an active research area. Recent work has focused on hardware (brain structure) and software (brain function and connectivity). However, understanding whether FS are an adaptive consequence of changes in brain structure, function, and/or connectivity is important for identifying a causative mechanism and for FS treatment and prevention. Further, investigation must also uncover what causes these structural and functional phenomena. Pioneering work in the field of psychoneuroimmunology has established a strong, consistent link between psychopathology, immune dysfunction, and brain structure/function. Based on this and recent FS biomarker findings, we propose a new etiologic model of FS pathophysiology. We hypothesize that early-life stressors cause neuroinflammatory and neuroendocrine changes that prime the brain for later FS development following secondary trauma (e.g., traumatic brain injury or psychological trauma). This framework coalesces existing knowledge regarding brain aberrations underlying FS and established neurobiological theories on the pathophysiology of underlying psychiatric disorders. We also propose brain temperature mapping as a way of indirectly visualizing neuroinflammation in patients with FS, particularly in emotion regulation, fear processing, and sensory-motor integration circuits. We offer a foundation on which future research can be built, with clear recommendations for future studies.
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Affiliation(s)
- Ayushe A Sharma
- Departments of Neurology, University of Alabama at Birmingham (UAB) Heersink School of Medicine, Birmingham, AL, USA.,UAB Epilepsy Center (UABEC), Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Departments of Neurology, University of Alabama at Birmingham (UAB) Heersink School of Medicine, Birmingham, AL, USA.,Departments of Neurosurgery, and University of Alabama at Birmingham (UAB) Heersink School of Medicine, Birmingham, AL, USA.,Departments of Neurobiology, University of Alabama at Birmingham (UAB) Heersink School of Medicine, Birmingham, AL, USA.,UAB Epilepsy Center (UABEC), Birmingham, AL, USA
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21
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Rocamora R, Chavarría B, Pérez E, Pérez-Enríquez C, Barguilla A, Panadés-de Oliveira L, Principe A, Zucca R. Mood Disturbances, Anxiety, and Impact on Quality of Life in Patients Admitted to Epilepsy Monitoring Units. Front Neurol 2021; 12:761239. [PMID: 34777230 PMCID: PMC8584435 DOI: 10.3389/fneur.2021.761239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/19/2021] [Accepted: 09/23/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: The overall combined prevalence of anxiety and depression in patients with epilepsy has been estimated at 20.2 and 22.9%, respectively, and is considered more severe in drug-refractory epilepsy. Patients admitted to epilepsy monitoring units constitute a particular group. Also, patients with psychogenic non-epileptic seizures can reach more than 20% of all admissions. This study aims to characterize these symptoms in a large cohort of patients admitted for evaluation in a tertiary epilepsy center. Materials and Methods: The study was conducted among 493 consecutive patients (age: 38.78 ± 12.7, 57% females) admitted for long-term video EEG from January 2013 to February 2021. Demographic, clinical, and mood disorder patients' data were collected. Anxiety and depression symptoms were assessed through the Hospital Anxiety Depression Scale (HADS-A and HADS-D), the State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Quality of life was determined using the QOLIE-10. Patients were divided into three groups: patients with epilepsy (n = 395), psychogenic non-epileptic seizures (PNES) (n = 56), and combined (n = 33). A univariate and multivariate regression analysis was performed for variables associated with quality of life. Results: Of 493 patients, 45.0% had structural etiology, and considering epilepsy classification, 43.6% were of temporal lobe origin. In addition, 32.45% of patients had a previous psychiatric history, 49.9% of patients had depressive symptoms in BDI, and 30.9% according to HADS-D; 56.42 and 52.63% of patients presented pathological anxiety scores in STAI-T and STAI-S, respectively; and 44.78% according to HADS-A. PNES and combined groups revealed a higher incidence of pathologic BDI scores (64.29 and 78.79%, p < 0.001) as well as pathologic HADS-A scores (p = 0.001). Anxiety and depression pathologic results are more prevalent in females, HADS-A (females = 50.7%, males = 36.8%; p = 0.0027) and BDI > 13 (females = 56.6%, males = 41.0%; p = 0.0006). QOLIE-10 showed that 71% of the patients had their quality of life affected with significantly higher scores in the combined group than in the epilepsy and PNES groups (p = 0.0015). Conclusions: Subjective anxiety, depression, and reduced quality of life are highly prevalent in patients with refractory epilepsy. These symptoms are more evident when PNES are associated with epilepsy and more severe among female patients. Most of the cases were not previously diagnosed. These factors should be considered in everyday clinical practice, and specific approaches might be adapted depending on the patient's profile.
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Affiliation(s)
- Rodrigo Rocamora
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain.,Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Beatriz Chavarría
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain
| | - Eva Pérez
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain
| | - Carmen Pérez-Enríquez
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Ainara Barguilla
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain
| | | | - Alessandro Principe
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain.,Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Riccardo Zucca
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain.,Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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22
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Abstract
The review provides epidemiological data and discuss the associated burden of non-epileptic seizures (PNES). Data on the prevalence, socio-demographic and clinical risk factors for the development of PNES are presented. The hypotheses of the PNES origin, including the contribution of psychological trauma, are considered. We also describe contemporary methods for differential diagnosis of epileptic seizures and PNES, including biomarkers and the use of diagnostic questionnaires. Special attention is given to the issues of the psychiatric comorbidity of PNES.
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Affiliation(s)
- G V Kustov
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - M S Zinchuk
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - F K Rider
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - E V Pashnin
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - N I Voinova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A S Avedisova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russia
| | - A B Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
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23
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Amiri S, Arbabi M, Rahimi M, Badragheh F, Zibadi HA, Asadi-Pooya AA, Mirbagheri MM. Effective connectivity between emotional and motor brain regions in people with psychogenic nonepileptic seizures (PNES). Epilepsy Behav 2021; 122:108085. [PMID: 34166951 DOI: 10.1016/j.yebeh.2021.108085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To characterize the effective connectivity (EC) between the emotion and motor brain regions in patients with psychogenic nonepileptic seizures (PNES), based on resting-state spectral dynamic causal modeling (spDCM). METHODS Twenty-three patients with PNES and twenty-five healthy control (HC) subjects underwent resting-state fMRI scanning. The coupling parameters indicating the causal interactions between eight brain regions associated with emotion, executive control, and motion were estimated for both groups, using resting-state fMRI spDCM. RESULTS Compared to the HC subjects, in patients with PNES: (i) the left insula (INS) and left and right inferior frontal gyri (IFG) are more inhibited by the amygdala (AMYG), anterior cingulate cortex (ACC), and precentral gyrus (PCG); (ii) the left AMYG has greater inhibitory effects on the INS, IFG, dorsolateral prefrontal cortex (DLPFC), PCG, and supplementary motor area (SMA); (iii) the left ACC has more inhibitory effects on the INS and IFG; (iv) the right ACC is more inhibited by the INS and IFG, and has a less inhibitory effect on the SMA and PCG; and (v) the left caudate (CAU) had increased inhibitory effects on the AMYG and IFG and a more excitatory effect on the SMA. CONCLUSION Our results suggest that in patients with PNES, the emotion-processing regions have inhibitory effects on the executive control areas and motor regions. Our findings may provide further insight into the influence of emotional arousal on functional movements and the underlying mechanisms of involuntary movements during functional seizures. Furthermore, they may suggest that emotion regulation through cognitive behavioral psychotherapies can be a potentially effective treatment modality.
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24
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Mameniškienė R, Puteikis K, Carrizosa-Moog J. Neurology specialists’ visual interpretation of psychogenic nonepileptic seizures: Contemplating their etiology and existing challenges. Seizure 2021; 90:175-181. [DOI: 10.1016/j.seizure.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/27/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
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25
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Damián A, Legnani M, Rada D, Braga P, Scaramelli A, Ferrando R. SPECT activation patterns in psychogenic non-epileptic seizures in temporal lobe epilepsy patients. Seizure 2021; 90:110-116. [DOI: 10.1016/j.seizure.2021.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022] Open
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26
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Labate A, Martino I, Caligiuri ME, Fortunato F, Bruni A, Segura-Garcia C, Arcuri P, De Fazio P, Cerasa A, Gambardella A. Orbito-frontal thinning together with a somatoform dissociation might be the fingerprint of PNES. Epilepsy Behav 2021; 121:108044. [PMID: 34051606 DOI: 10.1016/j.yebeh.2021.108044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/11/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate neuroanatomical changes in patients with psychogenic nonepileptic seizures (PNES) compared to major depressive disorder (MDD) and healthy controls. METHODS Forty-two drug-naïve PNES subjects and 25 patients with MDD, matched for demographic characteristics and level of depression (as measured by Beck Depression Inventory-II, BDI-II), were consecutively recruited. Patients performed an extensive neuropsychiatric assessment including: Hamilton Anxiety Rating Scale, Traumatic Experience Checklist, Dissociative Experiences Scale, Toronto Alexithymia Scale and Somatoform Dissociation Questionnaire (SDQ-20). All patients, together with 78 healthy matched controls, underwent 3T brain MRI followed by surface-based morphometry. RESULTS Cortical thickness analysis revealed significant cortical thinning in bilateral medial orbitofrontal cortex (OFC) and left rostral anterior cingulate cortex (ACC) in patients with MDD compared to subjects with PNES and controls. Interestingly, increased thickness of the right pars triangularis was found in PNES subjects compared to controls. PNES showed higher scores in SDQ-20 (p < 0.001) compared to MDD, which was corroborated by neuroimaging data, where somatoform dissociation scores correlated with morphological changes in the left medial OFC. CONCLUSION Our results show selective cortical thinning over the medial OFC in patients with PNES compared to wider regions of thinning in patients with MDD. Somatoform dissociation was the only psychopathological assessment significantly different in PNES and MDD.
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Affiliation(s)
- Angelo Labate
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy.
| | - Iolanda Martino
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Antonella Bruni
- Institute of Psychiatry, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Cristina Segura-Garcia
- Institute of Psychiatry, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Pierpaolo Arcuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Pasquale De Fazio
- Institute of Psychiatry, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Antonio Cerasa
- IRIB, National Research Council, Mangone, CS, Italy; S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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27
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Kerr WT, Lee JK, Karimi AH, Tatekawa H, Hickman LB, Connerney M, Sreenivasan SS, Dubey I, Allas CH, Smith JM, Savic I, Silverman DHS, Hadjiiski LM, Beimer NJ, Stacey WC, Cohen MS, Engel J, Feusner JD, Salamon N, Stern JM. A minority of patients with functional seizures have abnormalities on neuroimaging. J Neurol Sci 2021; 427:117548. [PMID: 34216975 DOI: 10.1016/j.jns.2021.117548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Functional seizures often are managed incorrectly as a diagnosis of exclusion. However, a significant minority of patients with functional seizures may have abnormalities on neuroimaging that typically are associated with epilepsy, leading to diagnostic confusion. We evaluated the rate of epilepsy-associated findings on MRI, FDG-PET, and CT in patients with functional seizures. METHODS We studied radiologists' reports from neuroimages at our comprehensive epilepsy center from a consecutive series of patients diagnosed with functional seizures without comorbid epilepsy from 2006 to 2019. We summarized the MRI, FDG-PET, and CT results as follows: within normal limits, incidental findings, unrelated findings, non-specific abnormalities, post-operative study, epilepsy risk factors (ERF), borderline epilepsy-associated findings (EAF), and definitive EAF. RESULTS Of the 256 MRIs, 23% demonstrated ERF (5%), borderline EAF (8%), or definitive EAF (10%). The most common EAF was hippocampal sclerosis, with the majority of borderline EAF comprising hippocampal atrophy without T2 hyperintensity or vice versa. Of the 87 FDG-PETs, 26% demonstrated borderline EAF (17%) or definitive EAF (8%). Epilepsy-associated findings primarily included focal hypometabolism, especially of the temporal lobes, with borderline findings including subtle or questionable hypometabolism. Of the 51 CTs, only 2% had definitive EAF. SIGNIFICANCE This large case series provides further evidence that, while uncommon, EAF are seen in patients with functional seizures. A significant portion of these abnormal findings are borderline. The moderately high rate of these abnormalities may represent framing bias from the indication of the study being "seizures," the relative subtlety of EAF, or effects of antiseizure medications.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - John K Lee
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hiroyuki Tatekawa
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Brian Hickman
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Internal Medicine, University of California at Irvine, Irvine, CA, USA
| | - Michael Connerney
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Ishita Dubey
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Corinne H Allas
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jena M Smith
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ivanka Savic
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Daniel H S Silverman
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lubomir M Hadjiiski
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas J Beimer
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - William C Stacey
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mark S Cohen
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Departments of Bioengineering, Psychology and Biomedical Physics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Noriko Salamon
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Asadi-Pooya AA, Beghi M, Baslet G. Is sexual trauma a risk factor for functional (psychogenic) seizures? Neurosci Biobehav Rev 2021; 128:58-63. [PMID: 34119526 DOI: 10.1016/j.neubiorev.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022]
Abstract
The relationship between functional seizures (FS) and sexual trauma has received attention in many previous studies. However, the mechanisms underlying this relationship have not been elucidated yet. The purpose of this narrative review is to explore and speculate on the underpinning neurobiological mechanisms for the association and link between sexual trauma and functional seizures. While existence of a causal relationship between a history of sexual trauma and functional seizures is plausible, it should be viewed and treated as a hypothesis. In explaining this hypothesis, we can speculate that interactions between genetic factors and a history of sexual trauma may contribute to the risk of experiencing functional seizures. Childhood sexual trauma may lead to structural and functional connectivity changes in the brain and dysregulation of the biological stress systems, particularly in women. These neurobiological changes speculatively may predispose patients to functional seizures later in life. Importantly, a history of sexual trauma has many other implications beyond the predisposition towards FS.
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29
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Sojka P, Paredes-Echeverri S, Perez DL. Are Functional (Psychogenic Nonepileptic) Seizures the Sole Expression of Psychological Processes? Curr Top Behav Neurosci 2021; 55:329-351. [PMID: 33768494 DOI: 10.1007/7854_2021_225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional [psychogenic nonepileptic/dissociative] seizures (FND-seiz) and related functional neurological disorder subtypes were of immense interest to early founders of modern-day neurology and psychiatry. Unfortunately, the divide that occurred between the both specialties throughout the mid-twentieth century placed FND-seiz at the borderland between the two disciplines. In the process, a false Cartesian dualism emerged that labeled psychiatric conditions as impairments of the mind and neurological conditions as disturbances in structural neuroanatomy. Excitingly, modern-day neuropsychiatric perspectives now consider neurologic and psychiatric conditions as disorders of both brain and mind. In this article, we aim to integrate neurologic and psychiatric perspectives in the conceptual framing of FND-seiz. In doing so, we explore emerging relationships between symptoms, neuropsychological constructs, brain networks, and neuroendocrine/autonomic biomarkers of disease. Evidence suggests that the neuropsychological constructs of emotion processing, attention, interoception, and self-agency are important in the pathophysiology of FND-seiz. Furthermore, FND-seiz is a multi-network brain disorder, with evidence supporting roles for disturbances within and across the salience, limbic, attentional, multimodal integration, and sensorimotor networks. Risk factors, including the magnitude of previously experienced adverse life events, relate to individual differences in network architecture and neuroendocrine profiles. The time has come to use an integrated neuropsychiatric approach that embraces the closely intertwined relationship between physical health and mental health to conceptualize FND-seiz and related functional neurological disorder subtypes.
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Affiliation(s)
- Petr Sojka
- Department of Psychiatry, University Hospital Brno, Brno, Czech Republic.
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Divisions, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology and Neuropsychiatry Divisions, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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30
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Perez DL, Nicholson TR, Asadi-Pooya AA, Bègue I, Butler M, Carson AJ, David AS, Deeley Q, Diez I, Edwards MJ, Espay AJ, Gelauff JM, Hallett M, Horovitz SG, Jungilligens J, Kanaan RAA, Tijssen MAJ, Kozlowska K, LaFaver K, LaFrance WC, Lidstone SC, Marapin RS, Maurer CW, Modirrousta M, Reinders AATS, Sojka P, Staab JP, Stone J, Szaflarski JP, Aybek S. Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Neuroimage Clin 2021; 30:102623. [PMID: 34215138 PMCID: PMC8111317 DOI: 10.1016/j.nicl.2021.102623] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using "rule-in" examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field. Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz Iran; Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Indrit Bègue
- Division of Adult Psychiatry, Department of Psychiatry, University of Geneva, Geneva Switzerland; Service of Neurology Department of Clinical Neuroscience, University of Geneva, Geneva, Switzerland
| | - Matthew Butler
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Quinton Deeley
- South London and Maudsley NHS Foundation Trust, London UK Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ibai Diez
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Edwards
- Neurosciences Research Centre, St George's University of London, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Jeannette M Gelauff
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health Heidelberg, Australia
| | - Marina A J Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia
| | - Kathrin LaFaver
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Ramesh S Marapin
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mandana Modirrousta
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Sojka
- Department of Psychiatry, University Hospital Brno, Czech Republic
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Rochester, MN, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham Epilepsy Center, Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Selma Aybek
- Neurology Department, Psychosomatic Medicine Unit, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
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Abstract
Functional or psychogenic seizures have proved a diagnostic and therapeutic challenge for centuries. Functional seizures can look and feel similar to epileptic seizures but are instead a common and highly disabling form of functional neurologic disorder, or conversion disorder. Consistent with the biopsychosocial model of mental illness, functional seizures are caused by biological, psychological, and social factors unrelated to epileptic discharges. People with functional seizures do not consciously fake their symptoms. Functional seizures can be differentiated from epileptic seizures through the clinical history, features of the seizures themselves, and electroencephalography findings. Psychotherapy is effective in treating functional seizures.
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Jungilligens J, Wellmer J, Kowoll A, Schlegel U, Axmacher N, Popkirov S. Microstructural integrity of affective neurocircuitry in patients with dissociative seizures is associated with emotional task performance, illness severity and trauma history. Seizure 2020; 84:91-98. [PMID: 33307466 DOI: 10.1016/j.seizure.2020.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To identify variations in white matter tract integrity related to behavioural control in response to emotional stimuli in patients with dissociative seizures (DS) and healthy controls (HC), and examine associations with illness characteristics and psychological trauma history. METHODS Twenty DS patients and 20 HC completed an emotional go/no-go task and questionnaires, and then underwent diffusion tensor imaging (DTI). RESULTS Patients had higher false alarm rates in response to negative emotional stimuli than HC. Task performance was correlated with self-reported difficulties in emotional awareness and regulation in everyday life. White matter analysis using tract-based spatial statistics revealed no between-group differences. In patients, fractional anisotropy (FA) in the right uncinate fasciculus, right and left fornix/stria terminalis, and corpus callosum were correlated with task performance. Similar results were found for radial diffusivity (RD), but not mean (MD) or axial diffusivity (AD). In HC, task performance was associated with AD and RD of fewer and smaller clusters in the corpus callosum and right fornix/stria terminalis, and none for FA or MD. Probabilistic tractography of thus identified tracts revealed that mean FA values were correlated with illness parameters (right fornix/stria terminalis with age at onset; posterior corpus callosum with seizure frequency), and psychological trauma history (traumatic experiences during adolescence with anterior corpus callosum). CONCLUSIONS Patients with DS show impaired behavioural control in response to emotional stimuli. Microstructural variations in task-related neurocircuitry show associations with illness parameters and psychological trauma history. Future studies using psychiatric controls should examine the specificity of these findings.
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Affiliation(s)
- Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.
| | - Jörg Wellmer
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Annika Kowoll
- Institute for Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
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Demartini B, Nisticò V, Edwards MJ, Gambini O, Priori A. The pathophysiology of functional movement disorders. Neurosci Biobehav Rev 2021; 120:387-400. [PMID: 33159917 DOI: 10.1016/j.neubiorev.2020.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 01/04/2023]
Abstract
Functional neurological disorder is characterized by neurological symptoms that cannot be explained by typical neurological diseases or other medical conditions. This review will critically discuss the literature on the pathophysiology of functional movement disorders (FMD), including functional neuroimaging studies, neurophysiological studies, studies on biomarkers and genetic studies. According to PRISMA guidelines for systematic reviews, we selected 39 studies. A complex scenario emerged, with the involvement of different areas of the brain in the pathophysiology of FMD. Our findings showed a hypoactivation of the contralateral primary motor cortex, a decreased activity in the parietal lobe, an aberrant activation of the amygdala, an increased temporo-parietal junction activity and a hyperactivation of insular regions in patients with FMD. Functional connectivity (FC) findings underlined aberrant connections between amygdala and motor areas, temporo-parietal junction and insula. We proposed amygdala hyperactivation as a possible biological marker for FMD and FC alterations between amygdala and other areas of the brain as consequent epiphenomena, accounting for the pathophysiological complexity of FMD. These conclusions might drive novel treatment hypotheses.
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34
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Alciati A, Shiffer D, Dipaola F, Barbic F, Furlan R. Psychogenic Pseudosyncope: Clinical Features, Diagnosis and Management. J Atr Fibrillation 2020; 13:2399. [PMID: 33024500 DOI: 10.4022/jafib.2399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/15/2020] [Accepted: 03/18/2020] [Indexed: 12/25/2022]
Abstract
Psychogenic Pseudosyncope (PPS) is the appearance of Transient Loss of Consciousness (TLOC) in which movements are absent, but there are no hemodynamic and electroencephalographic modifications as are induced by gravitational challenges which characterize syncope and true loss of consciousness. For younger and adult populations, a detailed history is crucial for the diagnosis. Clinical clues that should raise the suspicion for PPS include prolonged duration of the LOC, eye closure during the episode, unusual triggers, no recognizable prodromes and the high frequency of attacks. The presence of an established diagnosis of syncope should not deter from the concomitant diagnosis of PPS. The gold standard for a proper diagnosis of PPS is the documentation by a tilt test of normal hemodynamic and electroencephalographic parameters, when recorded during an attack. Treatment of PPS, based on the clear and empathetic communication of the diagnosis, can lead to an immediate reduction of attack frequency and lower the need to call on emergency services. Pharmacological treatment of associated psychiatric disorders and psychological interventions may be beneficial in patients with PPS. Cognitive-behavioural therapy holds the most reliable evidence of efficacy. In the present review, we aimed to address PPS with historical aspects, main clinical features and diagnostic tests, current diagnostic classification, underlying neurobiological abnormalities, management and therapy.
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Affiliation(s)
- Alessandra Alciati
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa S. Benedetto Menni Hospital, Albese con Cassano (CO), Italy
| | - Dana Shiffer
- Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Franca Dipaola
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Franca Barbic
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
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35
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Mesraoua B, Koepp M, Schuknecht B, Deleu D, Al Hail HJ, Melikyan G, Elsheikh L, Asadi-Pooya AA. Unexpected brain imaging findings in patients with seizures. Epilepsy Behav 2020; 111:107241. [PMID: 32590182 DOI: 10.1016/j.yebeh.2020.107241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/23/2020] [Revised: 04/26/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022]
Abstract
New imaging technologies have advanced our ability to localize the epileptogenic zone in patients with epilepsy. As a result of the constant improvement of the image quality, magnetic resonance imaging (MRI) has become the most important ancillary tool in the management of patients with epilepsy. Magnetic resonance imaging for the evaluation of patients with epilepsy should be done using a special temporal lobe protocol and read by physicians experienced with the findings in patients with epilepsy. On the other hand, in the healthy populations, incidental structural brain abnormalities have been reported in 18% of people. Incidental, subtle, or unexpected structural brain abnormalities have also been reported in many patients who were investigated because of having seizures. In the current narrative review, we will discuss some of these instances, where structural brain abnormalities are discovered unexpectedly, are subtle (but important) and/or may be considered as incidental.
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Affiliation(s)
- Boulenouar Mesraoua
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar.
| | | | | | - Dirk Deleu
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar.
| | - Hassan J Al Hail
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar.
| | - Gayane Melikyan
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar.
| | | | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA
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36
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Cerasa A, Gambardella A, Labate A. Terminology for psychogenic nonepileptic seizures: The contribution of neuroimaging. Epilepsy Behav 2020; 109:107063. [PMID: 32249033 DOI: 10.1016/j.yebeh.2020.107063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 11/22/2022]
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Madec T, Lagarde S, McGonigal A, Arthuis M, Benar CG, Bartolomei F. Transient cortico-cortical disconnection during psychogenic nonepileptic seizures (PNES). Epilepsia 2020; 61:e101-e106. [PMID: 32730658 DOI: 10.1111/epi.16623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are paroxysmal clinical events that are often misdiagnosed as epileptic seizures, but which are not associated with electrographic discharge. Brain connectivity changes occurring during PNES are not known. We studied functional connectivity (Fc) in two patients with drug-resistant epilepsy, explored by stereotactic electroencephalography (EEG), in whom we recorded both epileptic seizures (ES) and PNES. Functional connectivity using pair-wise nonlinear correlation was computed between signals from seven brain areas: amygdala, hippocampus, lateral temporal cortex, anterior insula, orbitofrontal cortex, prefrontal cortex, and lateral parietal cortex. We assessed changes in global Fc during PNES in comparison with a background period. During PNES, a global decrease of Fc occurred between the different brain regions studied, compared with the interictal period. In both patients, decreased Fc was prominent in connections involving the anterior insula and parietal cortex. In conclusion, some PNES are associated with ictal functional disconnection between brain areas, particularly involving the parietal cortices and the anterior insula.
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Affiliation(s)
- Tanguy Madec
- Epileptology Department, Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France
| | - Stanislas Lagarde
- Epileptology Department, Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France.,Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Aileen McGonigal
- Epileptology Department, Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France.,Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Marie Arthuis
- Epileptology Department, Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France
| | | | - Fabrice Bartolomei
- Epileptology Department, Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France.,Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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Kutlubaev MA, Mendelevich VD, Dyukova GM, Belousova ED. [The problem of comorbidity of epilepsy and psychogenic paroxysms]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:138-145. [PMID: 32621480 DOI: 10.17116/jnevro2020120051138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review of publications over the last two decades is presented. Psychogenic paroxysms develop in approximately 12% of patients with epilepsy. The analysis of social and demographic data, history details, semiological features and results of electrophysiological and neuroimaging studies does not unequivocally support the comorbidity of epilepsy and psychogenic paroxysms. The pathogenetic mechanisms of the development of comorbidity are various and depend on the presence of pharmacoresistance, psychological traumas in the past, intellectual disability etc. Video-EEG-monitoring is the gold standard in the diagnosis of comorbidity of epilepsy and psychogenic paroxysms. Treatment of such cases includes anticonvulsants and cognitive-behavioral therapy.
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Affiliation(s)
- M A Kutlubaev
- Kuvatov,Republican Clinical Hospital, Ufa, Russia.,Bashkir State Medical University, Ufa, Russia
| | | | - G M Dyukova
- Loginov Moscow Clinical Research Practical Center, Moscow, Russia
| | - E D Belousova
- Research Clinical Institute of Pediatric of Pirogov Russian National Research Medical University, Moscow, Russia
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39
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Anzellotti F, Dono F, Evangelista G, Di Pietro M, Carrarini C, Russo M, Ferrante C, Sensi SL, Onofrj M. Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge. Front Neurol 2020; 11:461. [PMID: 32582005 PMCID: PMC7280483 DOI: 10.3389/fneur.2020.00461] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 02/19/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are neurobehavioral conditions positioned in a gray zone, not infrequently a no-man land, that lies in the intersection between Neurology and Psychiatry. According to the DSM 5, PNES are a subgroup of conversion disorders (CD), while the ICD 10 classifies PNES as dissociative disorders. The incidence of PNES is estimated to be in the range of 1.4-4.9/100,000/year, and the prevalence range is between 2 and 33 per 100,000. The International League Against Epilepsy (ILAE) has identified PNES as one of the 10 most critical neuropsychiatric conditions associated with epilepsy. Comorbidity between epilepsy and PNES, a condition leading to "dual diagnosis," is a serious diagnostic and therapeutic challenge for clinicians. The lack of prompt identification of PNES in epileptic patients can lead to potentially harmful increases in the dosage of anti-seizure drugs (ASD) as well as erroneous diagnoses of refractory epilepsy. Hence, pseudo-refractory epilepsy is the other critical side of the PNES coin as one out of four to five patients admitted to video-EEG monitoring units with a diagnosis of pharmaco-resistant epilepsy is later found to suffer from non-epileptic events. The majority of these events are of psychogenic origin. Thus, the diagnostic differentiation between pseudo and true refractory epilepsy is essential to prevent actions that lead to unnecessary treatments and ASD-related side effects as well as produce a negative impact on the patient's quality of life. In this article, we review and discuss recent evidence related to the neurobiology of PNES. We also provide an overview of the classifications and diagnostic steps that are employed in PNES management and dwell on the concept of pseudo-resistant epilepsy.
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Affiliation(s)
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Camilla Ferrante
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Mind Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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40
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Abstract
This article reviews common and clinically important neuropsychiatric aspects of epilepsy. Comorbidities are common, underdiagnosed, and powerfully impact clinical outcomes. Biological, psychological, and social factors contribute to the associations between epilepsy and neuropsychiatric disorders. Epidemiologic studies point to a bidirectional relationships between epilepsy and neuropsychiatric disorders. People with epilepsy are more likely to develop certain neuropsychiatric disorders, and those with these disorders are more likely to develop epilepsy. This relationship suggests the possibility of shared underlying pathophysiologies. We review the neuropsychiatric impact of antiseizure medications and therapeutic options for treatment. Diagnosis and treatment involve close collaboration among a multidisciplinary team.
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Affiliation(s)
- Benjamin Tolchin
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA; Epilepsy Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA
| | - William Curt LaFrance
- Brown University, Rhode Island Hospital, Potter 3, 593 Eddy Street, Providence, RI 02903, USA
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41
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Gallucci-Neto J, Brunoni AR, Ono CR, Fiore LA, Martins Castro LH, Marchetti RL. Ictal SPECT in Psychogenic Nonepileptic and Epileptic Seizures. J Acad Consult Liaison Psychiatry 2020; 62:29-37. [PMID: 32641235 DOI: 10.1016/j.psym.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/03/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) are a common and debilitating problem in patients with epilepsy. They can be virtually indistinguishable from epileptic seizures, demanding video-electroencaphalogram monitoring, which is costly and not widely available, for differential diagnosis. Specific functional brain correlates of PNES have not been demonstrated so far. We hypothesized that PNES and epileptic seizures have distinct brain activation patterns, assessed by functional neuroimaging during ictal events of both conditions. OBJECTIVE Compare ictal brain activation patterns of PNES and epileptic seizures using single-photon emission computerized tomography. METHODS We prospectively assessed brain functional activation using single-photon emission computerized tomography 99mTc-ethyl cysteinate dimer in 26 patients with PNES, confirmed by trained psychiatrists in epileptology, who had their seizures induced by provocative tests compared with 22 age- and sex-matched subjects with temporal lobe epilepsy who underwent prolonged intensive video-electroencaphalogram monitoring. RESULTS In PNES patients compared with temporal lobe epilepsy group, we found a consistent increase in regional cerebral blood flow in the right precuneus (Brodmann area 7; P = 0.003) and right posterior cingulate cortex (Brodmann area 31; P = 0.001), as well as a decrease in regional cerebral blood flow in the right amygdala (P = 0.027). CONCLUSIONS Activation of default mode network brain areas and temporoparietal junction may be a distinct feature of ictal PNES and could be explained by a disruption between movement prediction input and sensory outcome. Such information mismatch might be the neurobiological underpinning of dissociative episodes.
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Affiliation(s)
- Jose Gallucci-Neto
- Neuropsychiatry Program, Department and Instidtute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Andre Russowsky Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carla Rachel Ono
- Department of Nuclear Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Lia Arno Fiore
- Neuropsychiatry Program, Department and Instidtute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Renato Luiz Marchetti
- Neuropsychiatry Program, Department and Instidtute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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42
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Kerr WT, Stern JM. We need a functioning name for PNES: Consider dissociative seizures. Epilepsy Behav 2020; 105:107002. [PMID: 32160585 DOI: 10.1016/j.yebeh.2020.107002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/21/2022]
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43
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Joos A, Halmer R, Leiprecht N, Schörner K, Lahmann C, Blahak C. [Functional neurological disorders: update and example of integrated inpatient treatment including mirror therapy]. Nervenarzt 2020; 91:252-256. [PMID: 31690969 DOI: 10.1007/s00115-019-00827-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- A Joos
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland.
- Psychotherapeutische Neurologie, Kliniken Schmieder, Gailingen, Deutschland.
| | - R Halmer
- Psychotherapeutische Neurologie, Kliniken Schmieder, Gailingen, Deutschland
| | - N Leiprecht
- Psychotherapeutische Neurologie, Kliniken Schmieder, Gailingen, Deutschland
| | - K Schörner
- Psychotherapeutische Neurologie, Kliniken Schmieder, Gailingen, Deutschland
| | - C Lahmann
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - C Blahak
- Klinik für Neurologie und Neurogeriatrie, Ortenau-Klinikum Lahr-Ettenheim, Lahr, Deutschland
- Neurologische Klinik, UniversitätsMedizin Mannheim, Universität Heidelberg, Mannheim, Deutschland
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Tatekawa H, Kerr WT, Savic I, Engel J, Salamon N. Reduced left amygdala volume in patients with dissociative seizures (psychogenic nonepileptic seizures). Seizure 2020; 75:43-8. [DOI: 10.1016/j.seizure.2019.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023] Open
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45
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Asadi-pooya AA, Homayoun M. Structural brain abnormalities in patients with psychogenic nonepileptic seizures. Neurol Sci 2020; 41:555-9. [DOI: 10.1007/s10072-019-04108-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
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46
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Barron E, Rotge JY. Talking about “psychogenic nonepileptic seizure” is wrong and stigmatizing. Seizure 2019; 71:6-7. [DOI: 10.1016/j.seizure.2019.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022] Open
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Affiliation(s)
- Rajeswari Aghoram
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, D. Nagar, Puducherry, India
| | - Pradeep P Nair
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, D. Nagar, Puducherry, India
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48
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Allendorfer JB, Nenert R, Hernando KA, DeWolfe JL, Pati S, Thomas AE, Billeaud N, Martin RC, Szaflarski JP. FMRI response to acute psychological stress differentiates patients with psychogenic non-epileptic seizures from healthy controls - A biochemical and neuroimaging biomarker study. Neuroimage Clin 2019; 24:101967. [PMID: 31446314 DOI: 10.1016/j.nicl.2019.101967] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/24/2019] [Accepted: 08/01/2019] [Indexed: 11/24/2022]
Abstract
We investigated psychological stress response in the brain regions involved in emotion-motor-executive control in psychogenic non-epileptic seizures (PNES). 12 PNES patients and 12 healthy controls (HCs) underwent stress task and resting state functional MRI (fMRI), mood and quality of life (QOL) assessments, and measurements of salivary cortisol, alpha-amylase, and heart rate. Group differences were assessed, and we correlated beta values from a priori selected brain regions showing stress task fMRI group differences with other stress response measures. We also used the regions showing stress task fMRI group differences as seeds for resting state functional connectivity (rs-FC) analysis. Mood and QOL were worse in PNES versus HCs. Physiological and assessment measures were similar except 'Planful Problem Solving' coping that was greater for HCs (p = .043). Perceived stress associated negatively with heart rate change (rs = -0.74, p = .0063). There was stress fMRI hyporeactivity in left/right amygdala and left hippocampus in PNES versus HCs (corrected p < .05). PNES exhibited a positive association between alpha-amylase change and right amygdala activation (rs = 0.71, p = .010). PNES versus HCs exhibited greater right amygdala rs-FC to left precentral and inferior/middle frontal gyri (corrected p < .05). Our findings of fMRI hyporeactivity to psychological stress, along with greater emotion-motor-executive control network rs-FC in PNES when compared to HCs suggest a dysregulation in stress response circuitry in PNES.
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Abstract
PURPOSE OF REVIEW This review addresses the scope, evaluation, treatments, and outcomes of patients with nonepileptic episodic events with a focus on psychogenic nonepileptic seizures. Differentiation of the types of events, including a review of terminology, is included, as well as a brief review of special patient populations with these disorders. RECENT FINDINGS There are continued efforts to develop tools to improve the diagnosis of these disorders. A thorough evaluation with trained personnel and physicians knowledgeable in the assessment and treatment of these disorders is important. Although inpatient video-EEG monitoring in an epilepsy monitoring unit remains the gold standard for diagnosis, the assessment of clinical and historical factors is critical and can be useful in expediting the process and improving diagnostic certainty. International efforts have recently assisted in providing guidelines for the evaluation of the psychogenic disorders and may help target educational and other resources to underserved areas. SUMMARY The prompt and accurate diagnosis of nonepileptic episodic events and psychogenic nonepileptic seizures is possible with current technology, and the appropriate and targeted use of evidence-based treatments may help improve patient quality of life and avoid unnecessary disability in patients with these disorders.
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Bègue I, Adams C, Stone J, Perez DL. Structural alterations in functional neurological disorder and related conditions: a software and hardware problem? Neuroimage Clin 2019; 22:101798. [PMID: 31146322 DOI: 10.1016/j.nicl.2019.101798] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023]
Abstract
Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A “software” vs. “hardware” analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including “disease staging” discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a “software” and “hardware” problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder. Transdiagnostic systematic review of structural MRI studies in FND and SSD Sensorimotor-striatothalamic-limbic-paralimbic circuits implicated in both conditions. Some small sample size FND studies did not show group-level structural alterations. MRI alterations may relate to risk factors, compensatory changes or disease mechanisms. Early-phase discussion on disease-staging algorithms outlined as a future direction.
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