Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Radiology, Westmead Hospital, Westmead, New South Wales, Australia.
Neuroimage Clin. 2022;35:103110. doi: 10.1016/j.nicl.2022.103110. Epub 2022 Jul 16.
Previous studies with adults suggest that aberrant communication between neural networks underpins functional neurological disorder (FND). The current study adopts a data-driven approach to investigate the extent that functional resting-state networks are disrupted in a pediatric mixed-FND cohort.
31 children with mixed FND and 33 age- and sex-matched healthy controls completed resting-state fMRI scans. Whole-brain independent component analysis (pFWE < 0.05) was then used to identify group differences in resting-state connectivity. Self-report measures included the Depression, Anxiety and Stress Scale (DASS-21) and Early Life Stress Questionnaire (ELSQ). Resting-state heart rate (HR) and cortisol-awakening response (CAR) were available in a subset.
Children with FND showed wide-ranging connectivity changes in eight independent components corresponding to eight resting-state neural networks: language networks (IC6 and IC1), visual network, frontoparietal network, salience network, dorsal attention network, cerebellar network, and sensorimotor network. Children whose clinical presentation included functional seizures (vs children with other FND symptoms) showed greater connectivity decreases in the frontoparietal and dorsal attentional networks. Subjective distress (total DASS score), autonomic arousal (indexed by HR), and HPA dysregulation (attenuated/reversed CAR) contributed to changes in neural network connectivity. Children with FND (vs controls) reported more subjective distress (total DASS score) and more adverse childhood experiences (ACEs) across their lifespan.
Children with FND demonstrate changes in resting-state connectivity. Identified network alterations underpin a broad range of functions typically disrupted in children with FND. This study complements the adult literature by suggesting that FND in children and adolescents emerges in the context of their lived experience and that it reflects aberrant communication across neural networks.
先前的成人研究表明，神经网络之间的异常通讯是功能性神经障碍（FND）的基础。本研究采用数据驱动的方法来研究儿科混合 FND 队列中功能静息态网络的破坏程度。
31 名患有混合 FND 的儿童和 33 名年龄和性别匹配的健康对照者完成了静息态 fMRI 扫描。然后使用全脑独立成分分析（pFWE < 0.05）来识别静息态连接中的组间差异。自我报告的测量包括抑郁、焦虑和压力量表（DASS-21）和早期生活应激问卷（ELSQ）。静息状态心率（HR）和皮质醇觉醒反应（CAR）在亚组中可用。
FND 患儿在对应八个静息态神经网络的八个独立成分中表现出广泛的连接变化：语言网络（IC6 和 IC1）、视觉网络、额顶网络、突显网络、背侧注意网络、小脑网络和感觉运动网络。临床表现包括功能性发作的患儿（与具有其他 FND 症状的患儿相比）在额顶和背侧注意网络中的连接减少更为明显。主观痛苦（总 DASS 评分）、自主唤醒（以 HR 为指标）和 HPA 失调（减弱/逆转的 CAR）导致神经网络连接发生变化。FND 患儿（与对照组相比）报告了更多的主观痛苦（总 DASS 评分）和更多的不良童年经历（ACEs）。
FND 患儿表现出静息态连接的变化。确定的网络改变为 FND 患儿中通常受到干扰的广泛功能提供了基础。这项研究通过表明儿童和青少年的 FND 是在他们的生活经历背景下出现的，并反映了神经网络之间的异常通讯，补充了成人文献。
