Popp Pauline, Zu Eulenburg Peter, Stephan Thomas, Bögle Rainer, Habs Maximilian, Henningsen Peter, Feuerecker Regina, Dieterich Marianne
Department of Neurology Ludwig-Maximilians Universität Munich Germany.
Graduate School of Systemic Neurosciences Ludwig-Maximilians Universität Munich Germany.
Ann Clin Transl Neurol. 2018 May 14;5(6):717-729. doi: 10.1002/acn3.570. eCollection 2018 Jun.
Functional dizziness syndromes are among the most common diagnoses made in patients with chronic dizziness, but their underlying neural characteristics are largely unknown. The aim of this neuroimaging study was to analyze the disease-specific brain changes in patients with phobic postural vertigo (PPV).
We measured brain morphology, task response, and functional connectivity in 44 patients with PPV and 44 healthy controls.
The analyses revealed a relative structural increase in regions of the prefrontal cortex and the associated thalamic projection zones as well as in the primary motor cortex. Morphological increases in the ventrolateral prefrontal cortex positively correlated with disease duration, whereas increases in dorsolateral, medial, and ventromedial prefrontal areas positively correlated with the Beck depression index. Visual motion stimulation caused an increased task-dependent activity in the subgenual anterior cingulum and a significantly longer duration of the motion aftereffect in the patients. Task-based functional connectivity analyses revealed aberrant involvement of interoceptive, fear generalization, and orbitofrontal networks.
Our findings agree with some of the typical characteristics of functional dizziness syndromes, for example, excessive self-awareness, anxious appraisal, and obsessive controlling of posture. This first evidence indicates that the disease-specific mechanisms underlying PPV are related to networks involved in mood regulation, fear generalization, interoception, and cognitive control. They do not seem to be the result of aberrant processing in cortical visual, visual motion, or vestibular regions.
功能性头晕综合征是慢性头晕患者最常见的诊断之一，但其潜在的神经特征在很大程度上尚不清楚。这项神经影像学研究的目的是分析恐惧姿势性眩晕（PPV）患者特定疾病的脑部变化。
我们测量了44例PPV患者和44名健康对照者的脑形态、任务反应和功能连接。
分析显示前额叶皮质区域及相关丘脑投射区以及初级运动皮质区域的相对结构增加。腹外侧前额叶皮质的形态学增加与疾病持续时间呈正相关，而背外侧、内侧和腹内侧前额叶区域的增加与贝克抑郁指数呈正相关。视觉运动刺激导致患者膝下前扣带回中与任务相关的活动增加，且运动后效应的持续时间明显延长。基于任务的功能连接分析显示内感受、恐惧泛化和眶额网络存在异常参与。
我们的研究结果与功能性头晕综合征的一些典型特征相符，例如过度的自我意识、焦虑评估和对姿势的强迫性控制。这一初步证据表明，PPV潜在的疾病特异性机制与参与情绪调节、恐惧泛化、内感受和认知控制的网络有关。它们似乎不是皮质视觉、视觉运动或前庭区域异常处理的结果。
