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Developing Neuroimaging Phenotypes of the Default Mode Network in PTSD: Integrating the Resting State, Working Memory, and Structural Connectivity

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Reduced limbic microstructural integrity in functional neurological disorder.

Ibai Diez^1,2,3,4, Benjamin Williams¹, Marek R Kubicki^5,6

¹Department of Neurology, Functional Neurology Research Group, Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Psychological Medicine

|November 27, 2019

Summary

This summary is machine-generated.

Functional neurological disorder (FND) involves white matter changes in key brain tracts. These microstructural differences in FND patients correlate with disability and illness duration, offering new insights into the disorder.

Keywords:

Conversion disorder DTI functional movement disorder psychogenic nonepileptic seizures somatization

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Area of Science:

Neuroscience
Psychiatry
Neurology

Background:

Functional neurological disorder (FND) presents challenges at the neurology-psychiatry interface.
While corticolimbic abnormalities are known, the role of white matter tracts in FND pathophysiology remains unclear.
This study investigates microstructural integrity of white matter tracts in FND.

Purpose of the Study:

To characterize differences in white matter microstructural integrity between FND patients and healthy controls.
To correlate fiber bundle integrity with FND symptom severity, physical disability, and illness duration.

Main Methods:

Diffusion Tensor Imaging (DTI) was used to study 32 FND patients and 36 healthy controls.
Graph theory and probabilistic tractography analyzed fractional anisotropy (FA) in cortico-subcortical connections.
Patient-reported outcomes included symptom severity, physical disability (SF-36), and illness duration.

Main Results:

FND patients exhibited reduced FA in multiple tracts, including the stria terminalis/fornix, medial forebrain bundle, and cingulum bundle, compared to controls.
These FA differences persisted after adjusting for depression and anxiety, except for the stria terminalis/fornix.
Physical disability inversely correlated with FA in the stria terminalis/fornix and medial forebrain bundle; illness duration negatively correlated with stria terminalis/fornix integrity.

Conclusions:

This is the first DTI study to reveal microstructural differences in limbic and associative tracts in mixed FND.
Findings highlight the involvement of specific neurocircuit pathways in FND pathophysiology.
Observed white matter alterations are linked to emotion regulation and salience processing deficits in FND.