Paulus Frieder Michel, Krach Sören, Blanke Marius, Roth Christine, Belke Marcus, Sommer Jens, Müller-Pinzler Laura, Menzler Katja, Jansen Andreas, Rosenow Felix, Bremmer Frank, Einhäuser Wolfgang, Knake Susanne
Department of Psychiatry and Psychotherapy, Social Neuroscience Lab, University of Lübeck, Lübeck, Germany; Department of Child- and Adolescent Psychiatry, University of Marburg, Marburg, Germany.
Department of Psychiatry and Psychotherapy, Social Neuroscience Lab, University of Lübeck, Lübeck, Germany.
Cortex. 2015 Apr;65:219-31. doi: 10.1016/j.cortex.2015.01.018. Epub 2015 Feb 7.
Emotional instability, difficulties in social adjustment, and disinhibited behavior are the most common symptoms of the psychiatric comorbidities in juvenile myoclonic epilepsy (JME). This psychopathology has been associated with dysfunctions of mesial-frontal brain circuits. The present work is a first direct test of this link and adapted a paradigm for probing frontal circuits during empathy for pain. Neural and psychophysiological parameters of pain empathy were assessed by combining functional magnetic resonance imaging (fMRI) with simultaneous pupillometry in 15 JME patients and 15 matched healthy controls. In JME patients, we observed reduced neural activation of the anterior cingulate cortex (ACC), the anterior insula (AI), and the ventrolateral prefrontal cortex (VLPFC). This modulation was paralleled by reduced pupil dilation during empathy for pain in patients. At the same time, pupil dilation was positively related to neural activity of the ACC, AI, and VLPFC. In JME patients, the ACC additionally showed reduced functional connectivity with the primary and secondary somatosensory cortex, areas fundamentally implicated in processing the somatic cause of another's pain. Our results provide first evidence that alterations of mesial-frontal circuits directly affect psychosocial functioning in JME patients and draw a link of pupil dynamics with brain activity during emotional processing. The findings of reduced pain empathy related activation of the ACC and AI and aberrant functional integration of the ACC with somatosensory cortex areas provide further evidence for this network's role in social behavior and helps explaining the JME psychopathology and patients' difficulties in social adjustment.
情绪不稳定、社会适应困难和行为抑制是青少年肌阵挛性癫痫（JME）精神共病最常见的症状。这种精神病理学与内侧额叶脑回路功能障碍有关。本研究首次直接验证了这种联系，并采用了一种在对疼痛产生共情时探测额叶回路的范式。通过功能磁共振成像（fMRI）与同步瞳孔测量相结合，对15名JME患者和15名匹配的健康对照者的疼痛共情神经和心理生理参数进行了评估。在JME患者中，我们观察到前扣带回皮质（ACC）、前脑岛（AI）和腹外侧前额叶皮质（VLPFC）的神经激活减少。这种调节与患者在对疼痛产生共情时瞳孔扩张减少相平行。同时，瞳孔扩张与ACC、AI和VLPFC的神经活动呈正相关。在JME患者中，ACC与主要和次要体感皮层的功能连接也减少，这些区域在处理他人疼痛的躯体原因方面起着根本作用。我们的结果首次证明内侧额叶回路的改变直接影响JME患者的心理社会功能，并揭示了瞳孔动态与情绪处理过程中大脑活动的联系。ACC和AI疼痛共情相关激活减少以及ACC与体感皮层区域异常功能整合的发现，为该网络在社会行为中的作用提供了进一步证据，并有助于解释JME的精神病理学以及患者在社会适应方面的困难。
