Neuroimaging evidence of structural and network disruptions in adolescents with conversion disorder with seizures

This study investigated structural and network-level brain alterations in adolescents with conversion disorder with attacks of seizures (CD/FS), focusing on stage-specific differences across acute and persistent presentations.

Sixty adolescents with CD/FS (26 acute-stage, 34 persistent-stage) and 60 age-matched controls underwent 3 T MRI. Voxel-based morphometry (VBM), source-based morphometry (SBM), and connectogram analyses were used to assess grey and white matter (GM and WM) alterations. Correlations with dissociative symptoms (DES scores) and age were evaluated.

Compared to controls, adolescents with CD/FS showed significant reductions in total GM and WM volumes. Acute-stage CD/FS was marked by localized GM increases in the mid-temporal poles and focal WM disruptions, while persistent-stage CD/FS exhibited widespread structural abnormalities, including volume reductions in the precuneus, posterior cingulate cortex, cerebellum, and cingulum. SBM revealed GM alterations in the hippocampus, lingual gyrus, putamen, and pallidum, along with WM changes in the midbrain and precuneus. Connectogram analysis showed progressive network disintegration-acute-stage CD/FS demonstrated localized disruptions in salience (SN) and default mode networks (DMN), whereas persistent-stage CD/FS showed widespread negative connectivity across SN, DMN, limbic, and executive networks.

Findings indicate that CD/FS in adolescents progresses from localized to widespread structural and network dysfunction. These findings highlight the importance of early identification of stage-specific brain network alterations in adolescents with functional seizures, which may support future efforts to develop prognostic markers and inform individualized clinical approaches.