Gray matter differences in patients with functional movement disorders
Carine W Maurer1, Kathrin LaFaver2, Gaurang S Limachia2
1From the Human Motor Control Section, Medical Neurology Branch (C.W.M., K.L., G.S.L., G.C., M.H., S.G.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (C.W.M.), Stony Brook University School of Medicine, NY; Department of Neurology (K.L.), University of Louisville, KY; Experimental Therapeutics and Pathophysiology Branch (R.A.) and Office of the Clinical Director (S.S.), National Institute of Mental Health, NIH, Bethesda, MD; and Department of Psychiatry (S.A.E.), Georgetown University, Washington, DC. carine.maurer@stonybrookmedicine.edu.
Objective:
To explore alterations in gray matter volume in patients with functional movement disorders.
Methods:
We obtained T1-weighted MRI on 48 patients with clinically definite functional movement disorders, a subset of functional neurologic symptom disorder characterized by abnormal involuntary movements, and on 55 age- and sex-matched healthy controls. We compared between-group differences in gray matter volume using voxel-based morphometry across the whole brain. All participants in addition underwent a thorough neuropsychological battery, including the Hamilton Anxiety and Depression Scales and the Childhood Trauma Questionnaire. To determine whether confounding factors such as comorbid depression, anxiety, or childhood trauma exposure contributed to the observed structural changes, nonparametric correlation analysis was performed.
Results:
Patients with functional movement disorders exhibited increased volume of the left amygdala, left striatum, left cerebellum, left fusiform gyrus, and bilateral thalamus, and decreased volume of the left sensorimotor cortex (whole-brain corrected p ≤ 0.05). Volumetric differences did not correlate with measures of disease duration or patient-rated disease severity.
Conclusion:
This study demonstrates that patients with functional movement disorders exhibit structural gray matter abnormalities in critical components of the limbic and sensorimotor circuitry. These abnormalities may represent a premorbid trait rendering patients more susceptible to disease, the disease itself, or a compensatory response to disease.
Insights
Patients with functional movement disorders show distinct gray matter volume changes in brain regions affecting emotion and movement. These structural differences may indicate a predisposition or response to the disorder.
Area of Science:
- Neuroimaging
- Neurology
- Psychiatry
Background:
- Functional movement disorders (FMDs) are neurological conditions characterized by abnormal involuntary movements.
- Understanding the underlying neurobiology of FMDs is crucial for diagnosis and treatment.
Purpose of the Study:
- To investigate alterations in gray matter volume in individuals diagnosed with FMDs.
- To identify specific brain regions affected by structural changes in FMD patients.
Main Methods:
- T1-weighted MRI scans were acquired from 48 FMD patients and 55 healthy controls.
- Voxel-based morphometry was employed to compare whole-brain gray matter volume differences.
- Correlation analyses examined the relationship between structural changes and clinical factors like depression, anxiety, and childhood trauma.
Main Results:
- FMD patients displayed increased gray matter volume in the left amygdala, left striatum, left cerebellum, left fusiform gyrus, and bilateral thalamus.
- A decreased gray matter volume was observed in the left sensorimotor cortex of FMD patients.
- No significant correlation was found between volumetric differences and disease duration or severity.
Conclusions:
- Functional movement disorders are associated with structural gray matter abnormalities.
- These abnormalities are located in key areas of the limbic and sensorimotor circuits.
- The observed changes may represent a premorbid trait, the disease process itself, or a compensatory mechanism.
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