Grossini Elena, Stecco Alessandro, Gramaglia Carla, De Zanet Daniel, Cantello Roberto, Gori Benedetta, Negroni Davide, Azzolina Danila, Ferrante Daniela, Feggi Alessandro, Carriero Alessandro, Zeppegno Patrizia
Laboratory of Physiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
Radiology Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
Front Neurosci. 2022 Aug 11;16:827998. doi: 10.3389/fnins.2022.827998. eCollection 2022.
BACKGROUND/AIM: Misophonia is a disorder characterized by reduced tolerance to specific sounds or stimuli known as "triggers," which tend to evoke negative emotional, physiological, and behavioral responses. In this study, we aimed to better characterize participants with misophonia through the evaluation of the response of the autonomic nervous system to "trigger sounds," a psychometric assessment, and the analysis of the neurological pathways.
Participants included 11 adults presenting with misophonic disturbance and 44 sex-matched healthy controls (HCs). Following recently proposed diagnostic criteria, the participants listened to six "trigger sounds" and a "general annoyance" sound (baby crying) during a series of physiological tests. The effects were examined through functional magnetic resonance imaging (fMRI), the analysis of heart rate variability (HRV), and of galvanic skin conductance (GSC). The fMRI was performed on a 3T Scanner. The HRV was obtained through the analysis of electrocardiogram, whereas the GSC was examined through the positioning of silver-chloride electrodes on fingers. Furthermore, the psychometric assessment included questionnaires focused on misophonia, psychopathology, resilience, anger, and motivation.
Participants with misophonia showed patterns of increased sympathetic activation in response to trigger sounds and a general annoyance sound, the low frequency (LF) component of HRV, the sympathetic index, and the number of significant GSC over the threshold, where the amplitude/phasic response of GSC was higher. The fMRI analysis provided evidence for the activation of the temporal cortex, the limbic area, the ventromedial prefrontal/premotor/cingulate cortex, and the cerebellum in participants with misophonia. In addition, the psychometric assessment seemed to differentiate misophonia as a construct independent from general psychopathology.
These results suggest the activation of a specific auditory-insula-limbic pathway at the basis of the sympathetic activation observed in participants with misophonia in response to "trigger and general annoyance sounds." Further studies should disentangle the complex issue of whether misophonia represents a new clinical disorder or a non-pathological condition. These results could help to build diagnostic tests to recognize and better classify this disorder. The relevance of this question goes beyond purely theoretical issues, as in the first case, participants with misophonia should receive a diagnosis and a targeted treatment, while in the second case, they should not.
背景/目的：恐音症是一种对特定声音或刺激（即“触发因素”）耐受性降低的疾病，这些触发因素往往会引发负面的情绪、生理和行为反应。在本研究中，我们旨在通过评估自主神经系统对“触发声音”的反应、进行心理测量评估以及分析神经通路，更好地对恐音症患者进行特征描述。
参与者包括11名患有恐音症困扰的成年人和44名性别匹配的健康对照者（HCs）。根据最近提出的诊断标准，参与者在一系列生理测试中听取六种“触发声音”和一种“一般恼人声音”（婴儿哭声）。通过功能磁共振成像（fMRI）、心率变异性（HRV）分析和皮肤电导率（GSC）分析来检查其影响。fMRI在3T扫描仪上进行。HRV通过心电图分析获得，而GSC通过将氯化银电极放置在手指上来检查。此外，心理测量评估包括针对恐音症、精神病理学、复原力、愤怒和动机的问卷。
恐音症患者在听到触发声音和一般恼人声音时，表现出交感神经激活增加的模式，HRV的低频（LF）成分、交感神经指数以及超过阈值的显著GSC数量增加，其中GSC的幅度/相位反应更高。fMRI分析为恐音症患者的颞叶皮质、边缘区域、腹内侧前额叶/运动前区/扣带回皮质和小脑的激活提供了证据。此外，心理测量评估似乎将恐音症作为一种独立于一般精神病理学的结构进行了区分。
这些结果表明，在恐音症患者对“触发声音和一般恼人声音”的反应中观察到的交感神经激活，其基础是特定的听觉-脑岛-边缘通路的激活。进一步的研究应理清恐音症是代表一种新的临床疾病还是一种非病理状态这一复杂问题。这些结果有助于建立诊断测试，以识别和更好地对这种疾病进行分类。这个问题的相关性超出了纯粹的理论问题，因为在第一种情况下，恐音症患者应接受诊断和针对性治疗，而在第二种情况下则不应如此。
