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Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder
Ibai Diez1,2,3,4, Laura Ortiz-Terán1,4, Benjamin Williams1
1Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Journal of Neurology, Neurosurgery, and Psychiatry
|March 10, 2019
Summary
Functional neurological disorder (FND) involves altered brain connectivity. This study found increased motor and amygdalar connectivity to key brain networks in FND patients, correlating with symptom severity and clinical outcomes.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Imaging
Background:
- Functional neurological disorder (FND) presents with motor and affective disturbances.
- Limbic hyper-reactivity and enhanced motor-limbic connectivity are observed in some FND patients.
- The multimodal integration network is crucial for processing sensorimotor, affective, and interoceptive information.
Purpose of the Study:
- To investigate altered resting-state functional connectivity in patients with motor FND.
- To examine motor and amygdalar propagation to the multimodal integration network.
- To correlate symptom severity and clinical outcomes with functional connectivity patterns.
Main Methods:
- Graph-theory stepwise functional connectivity (SFC) analysis was used.
- 30 motor FND patients and 30 healthy controls were compared.
- Within-group analyses correlated connectivity with symptom severity and 6-month outcomes.
Main Results:
- FND patients showed increased SFC from motor regions to the insula, TPJ, and cingulate cortex.
- Enhanced connectivity from the amygdala to the anterior insula, periaqueductal grey, and hypothalamus was observed in FND.
- Symptom severity correlated with altered insula-TPJ connectivity; clinical improvement correlated with amygdala-insula connectivity.
Conclusions:
- Neuroimaging findings suggest candidate neurocircuit pathways in FND pathophysiology.
- Altered connectivity within motor, limbic, and multimodal integration networks may underlie FND.
- These findings provide insights into the neural basis of FND symptoms and treatment response.
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