Sojka Petr, Serranová Tereza, Khalsa Sahib S, Perez David L, Diez Ibai
Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague (Sojka, Serranová); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, and Laureate Institute for Brain Research, Tulsa, Oklahoma (Khalsa); Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Division of Neuropsychiatry, Department of Psychiatry, and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Athinoula A. Martinos Center for Biomedical Imaging, and Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (Diez).
J Neuropsychiatry Clin Neurosci. 2025 Spring;37(2):149-159. doi: 10.1176/appi.neuropsych.20240070. Epub 2024 Nov 19.
Research suggests that disrupted interoception contributes to the development and maintenance of functional neurological disorder (FND); however, no functional neuroimaging studies have examined the processing of interoceptive signals in patients with FND.
The authors examined univariate and multivariate functional MRI neural responses of 38 patients with mixed FND and 38 healthy control individuals (HCs) during a task exploring goal-directed attention to cardiac interoception-versus-control (exteroception or rest) conditions. The relationships between interoception-related neural responses, heartbeat-counting accuracy, and interoceptive trait prediction error (ITPE) were also investigated for FND patients.
When attention was directed to heartbeat signals versus exteroception or rest tasks, FND patients showed decreased neural activations (and reduced coactivations) in the right anterior insula and bilateral dorsal anterior cingulate cortices (among other areas), compared with HCs. For FND patients, heartbeat-counting accuracy was positively correlated with right anterior insula and ventromedial prefrontal activations during interoception versus rest. Cardiac interoceptive accuracy was also correlated with bilateral dorsal anterior cingulate activations in the interoception-versus-exteroception contrast, and neural activations were correlated with ITPE scores, showing inverse relationships to those observed for heartbeat-counting accuracy.
This study identified state and trait interoceptive disruptions in FND patients. Convergent between- and within-group findings contextualize the pathophysiological role of cingulo-insular (salience network) areas across the spectrum of functional seizures and functional movement disorder. These findings provide a starting point for the future development of comprehensive neurophysiological assessments of interoception for FND patients, features that also warrant research as potential prognostic and monitoring biomarkers.
研究表明，内感受失调有助于功能性神经障碍（FND）的发展和维持；然而，尚无功能性神经影像学研究考察FND患者对内感受信号的处理。
作者在一项探索对心脏内感受与对照（外感受或休息）条件的目标导向性注意的任务中，检查了38例混合型FND患者和38名健康对照个体（HCs）的单变量和多变量功能磁共振成像神经反应。还研究了FND患者内感受相关神经反应、心跳计数准确性和内感受特质预测误差（ITPE）之间的关系。
与HCs相比，当注意力指向心跳信号而非外感受或休息任务时，FND患者右侧前脑岛和双侧背侧前扣带回皮质（以及其他区域）的神经激活减少（共激活减少）。对于FND患者，在对内感受与休息时，心跳计数准确性与右侧前脑岛和腹内侧前额叶激活呈正相关。在心脏内感受准确性与内感受与外感受对比中的双侧背侧前扣带回激活也相关，并且神经激活与ITPE评分相关，显示出与心跳计数准确性观察到的相反关系。
本研究确定了FND患者的状态和特质内感受失调。组间和组内的趋同结果将扣带回-脑岛（突显网络）区域在功能性癫痫和功能性运动障碍范围内的病理生理作用进行了情境化。这些发现为未来开发针对FND患者的内感受综合神经生理学评估提供了一个起点，这些特征也值得作为潜在的预后和监测生物标志物进行研究。
