University of Alabama at Birmingham, Birmingham, Alabama, USA.
Providence Veterans Affairs Medical Center, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.
Epilepsia. 2022 Apr;63(4):865-879. doi: 10.1111/epi.17179. Epub 2022 Feb 2.
This study was undertaken to determine whether undiagnosed illness duration (time between functional seizures [FS] onset and diagnosis) is linked to differences in neural response and functional connectivity during processing of stressful experiences.
Forty-nine participants with traumatic brain injury preceding the onset of FS confirmed by video-electroencephalography were recruited prospectively. Participants completed psychiatric symptom assessments before undergoing functional magnetic resonance imaging (fMRI) with an acute psychosocial stress task. Linear mixed effects (LME) analyses identified significant interactions between the factors of group (early vs. delayed diagnosis) and time lag to diagnosis on neural responses to stressful math performance and auditory feedback (corrected α = .05). Functional connectivity analysis utilized clusters from initial LME analyses as seed regions to determine significant interactions between these factors on network functional connectivity.
Demographic and psychiatric symptom measures were similar between early (n = 25) and delayed (n = 24) groups. Responses to stressful math performance within the left anterior insula and functional connectivity between the anterior insula seed region and a precentral gyrus cluster were significantly negatively correlated with time lag to diagnosis for the early but not the delayed FS diagnosis group. There was no correlation between fMRI findings and psychiatric symptoms.
This study indicates that aberrant left anterior insula activation and its functional connectivity to the precentral gyrus underlie differences in processing of stressful experiences in patients with delayed FS diagnosis. Follow-up comparisons suggest changes are associated with undiagnosed illness duration rather than psychiatric comorbidities and indicate a potential mechanistic association between neuropathophysiology, response to stressful experiences, and functional neuroanatomy in FS.
本研究旨在确定未确诊疾病持续时间（功能性癫痫发作[FS]发作与诊断之间的时间）是否与处理应激体验期间的神经反应和功能连接存在差异有关。
前瞻性招募了 49 名在 FS 发作前患有创伤性脑损伤且经视频-脑电图证实的患者。参与者在进行功能磁共振成像（fMRI）时完成了精神症状评估，同时进行了急性心理社会应激任务。线性混合效应（LME）分析确定了组（早期诊断与延迟诊断）和诊断时间延迟之间的因素之间存在显著交互作用，这些因素对应激性数学表现和听觉反馈的神经反应有影响（校正后的α=0.05）。功能连接分析利用初始 LME 分析中的簇作为种子区域，以确定这些因素之间在网络功能连接上的显著交互作用。
早期（n=25）和延迟（n=24）组的人口统计学和精神症状测量值相似。左前岛叶内的应激性数学表现反应以及前岛叶种子区域与中央前回簇之间的功能连接在早期 FS 诊断组与诊断时间延迟呈显著负相关，但在延迟 FS 诊断组中则没有相关性。fMRI 发现与精神症状之间无相关性。
本研究表明，异常的左前岛叶激活及其与中央前回的功能连接是导致延迟 FS 诊断患者处理应激体验存在差异的基础。后续比较表明，这些变化与未确诊疾病持续时间有关，而与精神共病无关，并表明 FS 中神经病理生理学、对应激体验的反应和功能神经解剖之间存在潜在的机制关联。
