Functional Neuroanatomy Underlying Psychogenic Non Epileptic Seizures. an Ictal SPECT Study
Abstract number :
2.206
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2022
Submission ID :
2204114
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:23 AM
Authors :
Victoria Ros Castello, MD – Montreal Neurological Institute; Maria Centeno, MD, PhD – Epilepsy Unit, Neurology Department, Hospital Clinic de Barcelona; Mahinda Yogarajah, MD, PhD – Clinical and Experimental Epilepsy – UCL Queen Square Institute of Neurology; Aida Niñerola, PhD – Nuclear Medicine – Hospital Clinic de Barcelona; Luis Pintor, MD, PhD – Psychiatry – Hospital Clinic de Barcelona; Samia Elkommos, MD – Epilepsy Unit, Neurology – King's College Hospital; Teresa Boget, PhD – Psychiatry – Hospital Clinic de Barcelona; Andres Perissinoti, MD, PhD – Nuclear Medicine – Hospital Clinic de Barcelona; Estefania Conde, MD – Epilepsy Unit, Neurology – Hospital Clinic de Barcelona; Mariam Alkhawaja, MD – Epilepsy Unit, Neurology – Hospital Clinic de Barcelona; Nuria Bargallo, Md, PhD – Neuroradiology – Hospital Clinic de Barcelona; Antonio Donaire, MD, PhD – Epilepsy Unit, Neurology – Hospital Clinic de Barcelona; Mar Carreño, MD, PhD – Epilepsy Unit, Neurology – Hospital Clinic de Barcelona; Xavier Setoain, MD, PhD – Nuclear Medicine – Hospital Clinic de Barcelona
Rationale: Psychogenic non-epileptic seizures (PNES) are part of functional conversion disorders. The neurobiological mechanisms underlying these disorders remain poorly understood. Recent research in this field is focusing on establishing neurobiological models to explain this disorder. It has been hypothesized that brain regions involved in the perception of external and internal stimuli (such as autonomic body changes), attention networks and networks involved in “self agency” may be implicated in the generation of PNES. Functional imaging such as ictal brain single-photon emission computed tomography (SPECT) can provide valuable information to characterize functional networks related to the generation PNES. The purpose of this study is to characterize the brain regions involved in the episodes of PNES using ictal and interictal SPECT.
Methods: Nineteen patients in whom ictal SPECT was obtained during an episode of PNES while admitted in the videoEEG monitoring unit were retrospectively reviewed. Ictal SPECTs were subtracted from the interictal SPECT to generate SISCOM (Subtraction of Ictal SPECT co-registered to MRI) images. Group analysis of the SISCOM images was conducted in order to identify common regions of activation and deactivation during the PNES episode across the group of patients. Whole-brain analysis, as well as hypothesis-based analysis on networks of interest, was performed using SPM.
Results: During PNES, there was increased activity in the medial prefrontal cortex, motor regions, anterior insula and basal ganglia, corresponding to regions involved in the perception of autonomic changes, sensory perception, motor control as well as attention networks. Conversely, there was reduced activity in the temporo-parieto-occipital junction bilaterally likely implying inhibition of areas associated with self-agency processes.
Conclusions: This study provides some insight into the brain regions that are involved in the generation of PNES. These findings may help to further explain the biological mechanisms involved in this disease.
Funding: None
Cormorbidity (Somatic and Psychiatric)