Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder
Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder
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DOI：
10.1136/jnnp-2018-319657
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发表时间：
2019-08-01
影响因子：
11
通讯作者：
Perez, David L.
中科院分区：
文献类型：
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作者：
Diez, Ibai;Ortiz-Teran, Laura;Perez, David L.
目的功能性神经障碍（FND）患者存在运动和情感障碍，沿着边缘系统高反应性和运动-边缘系统连接增强。鉴于多模态整合网络（颞叶，背扣带，颞顶连接（TPJ））涉及会聚感觉运动，情感和内感受性处理，我们假设FND患者会表现出改变运动和杏仁核静息状态传播到这个网络。还假设患者报告的症状严重程度和临床结局映射到多模式整合区域。方法采用图论逐步功能连接（SFC）方法，对30例FND患者和30例健康对照者的初级运动核和杏仁核（外侧基底核、中央内侧核）的组间差异进行研究。组内分析将功能传播特征与症状严重程度和前瞻性收集的6个月结局（通过躯体形式症状转换障碍子量表筛选和患者健康问卷-15综合评分测量）相关。对结果进行聚类校正以进行多重比较。结果与对照组相比，FND患者从运动区到双侧后岛叶、TPJ、中扣带回和壳核的SFC增加。从右侧基底杏仁核，FND队列显示出增强的连接到左前额叶，导水管周围灰质和下丘脑等区域。在组内分析中，症状严重程度与从左前额叶到右前额叶和TPJ的SFC增强相关;从左中央杏仁核到右前额叶的SFC增加与临床改善相关。组内关联控制了抑郁、焦虑和抗抑郁药的使用。结论这些影像学表现提示FND的病理生理学中可能存在神经回路通路。
Objective Some individuals with functional neurological disorder (FND) exhibit motor and affective disturbances, along with limbic hyper-reactivity and enhanced motor-limbic connectivity. Given that the multimodal integration network (insula, dorsal cingulate, temporoparietal junction (TPJ)) is implicated in convergent sensorimotor, affective and interoceptive processing, we hypothesised that patients with FND would exhibit altered motor and amygdalar resting-state propagation to this network. Patient-reported symptom severity and clinical outcome were also hypothesised to map onto multimodal integration areas. Methods Between-group differences in primary motor and amygdalar nuclei (laterobasal, centromedial) were examined using graph-theory stepwise functional connectivity (SFC) in 30 patients with motor FND compared with 30 healthy controls. Within-group analyses correlated functional propagation profiles with symptom severity and prospectively collected 6-month outcomes as measured by the Screening for Somatoform Symptoms Conversion Disorder subscale and Patient Health Questionnaire-15 composite score. Findings were clusterwise corrected for multiple comparisons. Results Compared with controls, patients with FND exhibited increased SFC from motor regions to the bilateral posterior insula, TPJ, middle cingulate cortex and putamen. From the right laterobasal amygdala, the FND cohort showed enhanced connectivity to the left anterior insula, periaqueductal grey and hypothalamus among other areas. In within-group analyses, symptom severity correlated with enhanced SFC from the left anterior insula to the right anterior insula and TPJ; increased SFC from the left centromedial amygdala to the right anterior insula correlated with clinical improvement. Within-group associations held controlling for depression, anxiety and antidepressant use. Conclusions These neuroimaging findings suggest potential candidate neurocircuit pathways in the pathophysiology of FND.