Laboratoire de Recherche en Neuroimagerie (LREN), Département des Neurosciences Cliniques (DNC), Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, Lausanne, Switzerland.
Laboratoire de Recherche en Neuroimagerie (LREN), Département des Neurosciences Cliniques (DNC), Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, Lausanne, Switzerland Bioinformatics Core Facility, Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland.
J Neurol Neurosurg Psychiatry. 2016 Mar;87(3):332-7. doi: 10.1136/jnnp-2014-309483. Epub 2015 Apr 8.
Psychogenic non-epileptic seizures (PNES) are involuntary paroxysmal events that are unaccompanied by epileptiform EEG discharges. We hypothesised that PNES are a disorder of distributed brain networks resulting from their functional disconnection.The disconnection may underlie a dissociation mechanism that weakens the influence of unconsciously presented traumatising information but exerts maladaptive effects leading to episodic failures of behavioural control manifested by psychogenic 'seizures'.
To test this hypothesis, we compared functional connectivity (FC) derived from resting state high-density EEGs of 18 patients with PNES and 18 age-matched and gender-matched controls. To this end, the EEGs were transformed into source space using the local autoregressive average inverse solution. FC was estimated with a multivariate measure of lagged synchronisation in the θ, α and β frequency bands for 66 brain sites clustered into 18 regions. A multiple comparison permutation test was applied to deduce significant between-group differences in inter-regional and intraregional FC.
The significant effect of PNES-a decrease in lagged FC between the basal ganglia and limbic, prefrontal, temporal, parietal and occipital regions-was found in the α band.
We believe that this finding reveals a possible neurobiological substrate of PNES, which explains both attenuation of the effect of potentially disturbing mental representations and the occurrence of PNES episodes. By improving understanding of the aetiology of this condition, our results suggest a potential refinement of diagnostic criteria and management principles.
心因性非癫痫性发作（PNES）是一种无意识的阵发性事件，没有癫痫样 EEG 放电伴随。我们假设 PNES 是分布式脑网络的紊乱，是由于其功能连接中断所致。这种断开可能是分离机制的基础，该机制削弱了无意识呈现的创伤性信息的影响，但会产生适应不良的影响，导致行为控制的阵发性失败，表现为心因性“发作”。
为了验证这一假设，我们比较了 18 例 PNES 患者和 18 例年龄和性别匹配的对照组在静息状态下高密度 EEG 得出的功能连接（FC）。为此，使用局部自回归平均逆解将 EEG 转换为源空间。使用滞后同步的多变量测量方法，在θ、α和β频段对 66 个大脑部位进行了估计，这些部位聚类为 18 个区域。应用多重比较置换检验来推断组间和区域内 FC 的显著差异。
在α频段，我们发现了 PNES 的显著影响——基底节与边缘、前额叶、颞叶、顶叶和枕叶区域之间的滞后 FC 减少。
我们认为这一发现揭示了 PNES 的一种可能的神经生物学基础，它解释了潜在干扰心理表象的效应的衰减和 PNES 发作的发生。通过提高对这种情况病因的理解，我们的结果表明潜在的诊断标准和管理原则的细化。
