Corticolimbic structural alterations linked to health status and trait anxiety in functional neurological disorder

Authors

David L. Perez, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Benjamin Williams, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Nassim Matin, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
W Curt LaFrance, Neuropsychiatry and Behavioral Neurology Division, Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Alpert Medical School, Providence, Rhode Island, USA.
Victor Costumero-Ramos, Department of Methodology, University of Valencia, Valencia, Spain.
Gregory L. Fricchione, Department of Psychiatry, Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Jorge Sepulcre, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA.
Matcheri S. Keshavan, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Bradford C. Dickerson, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA.

Document Type

Article

Abstract

OBJECTIVE: Affective symptoms influence health status (health-related quality of life) in functional neurological disorder (FND), and the salience network is implicated in the pathophysiology of FND and mood/anxiety disorders. We hypothesised that self-reported health status and affective symptoms would map onto salience network regions and that patients with FND would show decreased insular volumes compared with controls. METHODS: This voxel-based morphometry study investigated volumetric differences in 26 patients with FND (21 women, 5 men; mean age=40.3±11.5) compared with 27 healthy controls (22 women, 5 men; mean age=40.5±10.8). Post hoc analyses stratified patients with FND by mental and physical health scores (Short Form Health Survey-36). Within-group analyses investigated associations with mental health, physical health, trait anxiety and depression in patients with FND. RESULTS: There were no volumetric differences between the complete FND cohort and controls. In stratified analyses, however, patients with FND reporting the most severe physical health impairments showed reduced left anterior insular volume compared with controls. In within-group analyses, impaired mental health and elevated trait anxiety were associated with increased right amygdalar volumes in patients with FND. The relationship between amygdalar volume and mental health, driven by emotional well-being deficits and role limitations due to emotional problems, was independent of sensorimotor functional neurological symptom severity and motor FND subtype. In secondary within-group analyses, increased periaqueductal grey volume was associated with role limitations due to emotional problems. Impaired physical functioning correlated with decreased left anterior insular volumes. CONCLUSIONS: These findings support roles for several regions of the salience network in the pathophysiology of FND.

Medical Subject Headings

Adult; Affect; Anxiety (psychology); Cerebral Cortex (pathology); Cohort Studies; Diagnostic and Statistical Manual of Mental Disorders; Female; Gray Matter (pathology); Health Status; Humans; Limbic System (pathology); Magnetic Resonance Imaging; Male; Middle Aged; Nervous System Diseases (pathology, psychology); Neuropsychological Tests; Young Adult

Publication Date

12-1-2017

Publication Title

Journal of neurology, neurosurgery, and psychiatry

E-ISSN

1468-330X

Volume

88

Issue

12

First Page

1052

Last Page

1059

PubMed ID

28844071

Digital Object Identifier (DOI)

10.1136/jnnp-2017-316359

Recommended Citation

Perez, David L.; Williams, Benjamin; Matin, Nassim; LaFrance, W Curt; Costumero-Ramos, Victor; Fricchione, Gregory L.; Sepulcre, Jorge; Keshavan, Matcheri S.; and Dickerson, Bradford C., "Corticolimbic structural alterations linked to health status and trait anxiety in functional neurological disorder" (2017). Neurology. 1505.
https://scholar.barrowneuro.org/neurology/1505