An integrative neurocircuit perspective on psychogenic nonepileptic seizures and functional movement disorders: neural functional unawareness.
An integrative neurocircuit perspective on psychogenic nonepileptic seizures and functional movement disorders: neural functional unawareness.
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DOI：
10.1177/1550059414555905
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发表时间：
2015-01
影响因子：
2
通讯作者：
Silbersweig DA
中科院分区：
文献类型：
--
作者：
Perez DL;Dworetzky BA;Dickerson BC;Leung L;Cohn R;Baslet G;Silbersweig DA
功能性神经障碍（转换障碍）是神经科医生经常遇到的一种神经行为疾病。心因性非癫痫发作（PNES）和功能性运动障碍（FMD）患者分别出现在癫痫学家和运动障碍专家面前，然而神经学家缺乏神经生物学的视角来理解这些神秘的群体。观察性研究表明，PNES和FMD可能代表了相似（或相同）条件的变体，因为这两组都表现出女性优势，情绪焦虑障碍的患病率增加，经常承认先前的虐待，并且具有相同的表型特征。本文综述了PNES和FMD的神经影像学研究，并结合运动控制背景下的情绪失调、解离和心理创伤的研究进行了讨论。收敛性神经影像学发现涉及调节情绪表达、调节和意识（前扣带和腹内侧前额叶皮质、脑岛、杏仁核、蚓部）、认知控制和运动抑制（前扣带背侧、前额叶背外侧、额叶下皮质）、自我参照加工和知觉意识（后顶叶皮质、颞顶叶交界处）的脑回路的改变。运动规划和协调（小脑辅助运动区）。前额叶-顶叶网络的纹状体-丘脑成分也可能在病理生理中发挥作用。慢性应激介导的内侧前额叶和杏仁核神经可塑性改变可能促进部分患者神经功能症状的发展。提高对PNES和口蹄疫的生物学认识可能会减少耻辱感，并有助于识别指导治疗开发、选择和预后的神经成像生物标志物。进一步的研究应该调查功能性神经障碍亚型内部和之间的神经回路异常，并将PNES和FMD与情绪-焦虑-分离性障碍进行比较。
Functional Neurological Disorder (conversion disorder) is a neurobehavioral condition frequently encountered by neurologists. Psychogenic Non-Epileptic Seizure (PNES) and Functional Movement Disorder (FMD) patients present to epileptologists and movement disorder specialists respectively, yet neurologists lack a neurobiological perspective through which to understand these enigmatic groups. Observational research studies suggest that PNES and FMD may represent variants of similar (or the same) conditions given that both groups exhibit a female predominance, have increased prevalence of mood-anxiety disorders, frequently endorse prior abuse, and share phenotypic characteristics. In this perspective article, neuroimaging studies in PNES and FMD are reviewed, and discussed using studies of emotional dysregulation, dissociation and psychological trauma in the context of motor control. Convergent neuroimaging findings implicate alterations in brain circuits mediating emotional expression, regulation and awareness (anterior cingulate and ventromedial prefrontal cortices, insula, amygdala, vermis), cognitive control and motor inhibition (dorsal anterior cingulate, dorsolateral prefrontal, inferior frontal cortices), self-referential processing and perceptual awareness (posterior parietal cortex, temporoparietal junction), and motor planning and coordination (supplementary motor area, cerebellum). Striatal-thalamic components of prefrontal-parietal networks may also play a role in pathophysiology. Aberrant medial prefrontal and amygdalar neuroplastic changes mediated by chronic stress may facilitate the development of functional neurological symptoms in a subset of patients. Improved biological understanding of PNES and FMD will likely reduce stigma and aid the identification of neuroimaging biomarkers guiding treatment development, selection and prognosis. Additional research should investigate neurocircuit abnormalities within and across functional neurological disorder subtypes, as well as compare PNES and FMD to mood-anxiety-dissociative disorders.
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