White Matter Changes after Neurobehavioral Therapy for Functional Seizures.

Area of Science:

• Neuroimaging
• Neuroscience
• Neurology

Background:

• Functional seizures (FS) are often associated with traumatic brain injury (TBI).
• White matter integrity is crucial for neurological function.
• Neurobehavioral therapy (NBT) is a potential treatment for FS.

Purpose of the Study:

• To quantify white matter changes after NBT in patients with TBI and FS using neurite orientation dispersion and density imaging (NODDI).
• To investigate correlations between white matter plasticity and improvements in affective, postconcussive, and quality of life symptoms.

Main Methods:

• Prospective study involving 42 patients with TBI and FS (TBI+FS) and 47 controls with TBI without FS (TBI-only).
• Neuroimaging (NODDI) and behavioral data collected pre- and post-NBT for the TBI+FS group.
• Comparison of changes in neurite density, orientation dispersion index (ODI), and free water (FW) between groups.

Main Results:

• Significant ODI increases in the left uncinate fasciculus in TBI+FS patients correlated with improved posttraumatic symptoms, quality of life, emotional well-being, and energy.
• In TBI-only controls, ODI decreased and FW increased in the right cingulum, correlating with increased psychological problems.
• NBT reduced seizure frequency by 3.5 per week in TBI+FS patients, but imaging changes did not correlate with seizure frequency.

Conclusions:

• NBT induces white matter changes in patients with FS that are associated with improved psychosocial functioning.
• NODDI is a valuable tool for assessing the mechanisms of therapeutic interventions in FS.
• This study highlights the potential of NBT to promote brain plasticity and improve outcomes in TBI patients with FS.