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Limbic neurochemical changes in patients with functional motor symptoms
Benedetta Demartini1, Orsola Gambini1, Carla Uggetti1
1From the Dipartimento di Scienze della Salute (B.D., O.G., D.G., R.F., A.P.), Università degli Studi di Milano; Unità di Psichiatria II (B.D., O.G., D.G.) and III Clinica Neurologica (R.F., A.P.), and Neuroradiology Unit, Radiology Department (C.U., M. Cariati), ASST Santi Paolo e Carlo, Milan; Philips Health Care (M. Cadioli), Monza; Dipartimento di Ingegneria e Architettura (S.M.), Università degli Studi di Trieste; and "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics (B.D., O.G., R.F., A.P.), University of Milan, Italy.
Objective:
To assess by magnetic resonance spectroscopy (MRS) the N-acetylaspartate, myo-inositol, choline, sum of glutamate and glutamine (Glx), and creatine (Cr) content in the anterior cingulate cortex (ACC)/medial prefrontal cortex (mPFC) and in the occipital cortex (OCC) (control region) in patients with functional motor symptoms (FMS) and healthy controls, and to determine whether neurochemical limbic changes as estimated by MRS correlate with FMS-related motor symptom severity, alexithymia, anxiety, depression, and quality of life.
Methods:
This case-control study enrolled 10 patients with FMS and 10 healthy controls. Participants underwent MRS and were tested with the Mini-Mental State Examination, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, 20-Item Toronto Alexithymia Scale, and EuroQol 5D.
Results:
In patients with FMS, MRS showed increased Glx/Cr in the ACC/mPFC but normal content in the control OCC. All the other metabolites tested were normal in both regions. The increased Glx/Cr content in the ACC/mPFC correlated with alexithymia, anxiety, and severity of symptoms.
Conclusions:
The abnormal limbic Glx increase could have a crucial pathophysiologic role in FMS, possibly by altering limbic-motor interactions, ultimately leading to abnormal movements.
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