Szaflarski Jerzy P, Allendorfer Jane B, Nenert Rodolphe, LaFrance W Curt, Barkan Helen I, DeWolfe Jennifer, Pati Sandipan, Thomas Ashley E, Ver Hoef Lawrence
Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Epilepsy Behav. 2018 Feb;79:193-204. doi: 10.1016/j.yebeh.2017.12.004. Epub 2018 Jan 6.
Studies of emotion processing are needed to better understand the pathophysiology of psychogenic nonepileptic seizures (PNES). We examined the differences in facial emotion processing between 12 patients with PNES, 12 patients with temporal lobe epilepsy (TLE), and 24 matched healthy controls (HCs) using fMRI with emotional faces task (EFT) (happy/sad/fearful/neutral) and resting state connectivity. Compared with TLE, patients with PNES exhibited increased fMRI response to happy, neutral, and fearful faces in visual, temporal, and/or parietal regions and decreased fMRI response to sad faces in the putamen bilaterally. Regions showing significant differences between PNES and TLE were used as functional seed regions of interest (ROIs), in addition to amygdala structural seed ROIs for resting state functional connectivity analyses. Whole brain analyses showed that compared with TLE and HCs, patients with PNES exhibited increased functional connectivity of the functional seed ROIs to several brain regions, particularly to cerebellar, visual, motor, and frontotemporal regions. Connectograms showed increased functional connections between left parahippocampal gyrus/uncus ROIs and right temporal ROIs in PNES compared with both the TLE and HC groups. Resting state functional connectivity of the left and right amygdala to various brain regions including emotion regulation and motor control circuits was increased in PNES when compared with those with TLE. This study provides preliminary evidence that patients with PNES exhibit altered facial emotion processing compared with patients with TLE and HCs and increased amygdala functional connectivity compared with TLE. These findings identify potential key differences in facial emotion processing reflective of neurophysiologic markers of neural circuitry alterations that can be used to generate further hypotheses for developing studies that examine the contributions of emotion processing to the development and maintenance of PNES.
需要进行情绪加工研究，以更好地理解心因性非癫痫性发作（PNES）的病理生理学。我们使用功能性磁共振成像（fMRI）结合情绪面孔任务（EFT）（开心/悲伤/恐惧/中性）和静息态连接性，研究了12例PNES患者、12例颞叶癫痫（TLE）患者和24例匹配的健康对照（HC）之间面部情绪加工的差异。与TLE患者相比，PNES患者在视觉、颞叶和/或顶叶区域对开心、中性和恐惧面孔的fMRI反应增强，而双侧壳核中对悲伤面孔的fMRI反应减弱。除了杏仁核结构种子感兴趣区域（ROIs）用于静息态功能连接分析外，PNES和TLE之间显示出显著差异的区域被用作功能性种子感兴趣区域（ROIs）。全脑分析表明，与TLE患者和HC相比，PNES患者功能性种子ROIs与几个脑区之间的功能连接性增加，特别是与小脑、视觉、运动和额颞叶区域。连接图显示，与TLE组和HC组相比，PNES患者左侧海马旁回/钩回ROIs与右侧颞叶ROIs之间的功能连接增加。与TLE患者相比，PNES患者左右杏仁核与包括情绪调节和运动控制回路在内的各种脑区的静息态功能连接性增加。这项研究提供了初步证据，表明与TLE患者和HC相比，PNES患者表现出面部情绪加工改变，与TLE相比杏仁核功能连接性增加。这些发现确定了面部情绪加工中潜在的关键差异，反映了神经回路改变的神经生理学标志物，可用于生成进一步的假设，以开展研究来检验情绪加工对PNES发生和维持的作用。
