Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Neurol Neurosurg Psychiatry. 2017 Dec;88(12):1052-1059. doi: 10.1136/jnnp-2017-316359. Epub 2017 Aug 26.
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.
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.
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.
These findings support roles for several regions of the salience network in the pathophysiology of FND.
情感症状会影响功能性神经障碍（FND）患者的健康状况（与健康相关的生活质量），突显网络与 FND 和情绪/焦虑障碍的病理生理学有关。我们假设，自我报告的健康状况和情感症状与突显网络区域相关，并且 FND 患者的脑岛体积会比对照组小。
这项基于体素的形态计量学研究调查了 26 名 FND 患者（21 名女性，5 名男性；平均年龄=40.3±11.5）与 27 名健康对照者（22 名女性，5 名男性；平均年龄=40.5±10.8）之间的体积差异。对 FND 患者按心理健康和身体健康评分（健康调查短表-36）进行了事后分析。对 FND 患者进行了组内分析，以调查与心理健康、身体健康、特质焦虑和抑郁的关联。
FND 患者的全队列与对照组之间没有体积差异。然而，在分层分析中，报告身体状况最严重受损的 FND 患者的左侧前脑岛体积比对照组小。在组内分析中，心理健康受损和特质焦虑升高与 FND 患者的右侧杏仁核体积增加有关。在由情绪幸福感缺陷和情绪问题导致的角色限制驱动的情况下，杏仁核体积与心理健康之间的关系与感觉运动性 FND 症状严重程度和运动 FND 亚型无关。在二次组内分析中，增加的导水管周围灰质体积与情绪问题导致的角色限制有关。身体功能受损与左侧前脑岛体积减小相关。
这些发现支持突显网络的几个区域在 FND 的病理生理学中的作用。
