Case Report: Atonic PNES Capture in fMRI

Area of Science:

• Neuroscience
• Clinical Psychology
• Medical Imaging

Background:

• Psychogenic Non-Epileptic Seizures (PNES) are disabling events lacking epileptic activity, with underlying mechanisms poorly understood due to their transient nature.
• Previous resting-state fMRI studies indicate abnormal functional connectivity in limbic and motor systems in PNES patients.

Observation:

• A 23-year-old woman with PTSD experienced a PNES atonic episode during a 3T fMRI scan.
• fMRI data preprocessing included standard steps, with seizure periods contrasted against pre-seizure resting states.

Findings:

• Whole-brain analysis revealed significant activations in the left inferior temporal gyrus and temporo-occipital junction.
• Deactivations were observed in the right precuneus, superior parietal lobule, postcentral gyrus, bilateral occipital and cerebellar regions, and right insula.
• These brain changes involved networks related to emotional processing, agency, self-perception, and dissociation.

Implications:

• This is the first reported fMRI study conducted during a PNES episode.
• Results support the hypothesis that emotional and dissociative processes are central to PNES pathophysiology.
• Identifies potential targets for future neuromodulation therapies for PNES.