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Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures

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Abstract
Introduction Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures, but lack epileptiform brain activity. Instead, the cause is assumed to be psychogenic. An abnormal coping strategy may be exhibited by PNES patients, as indicated by their increased tendency to dissociate. Investigation of resting-state networks may reveal altered routes of information and emotion processing in PNES patients. The authors therefore investigated whether PNES patients differ from healthy controls in their resting-state functional connectivity characteristics and whether these connections are associated with the tendency to dissociate. Methods 11 PNES patients without psychiatric comorbidity and 12 healthy controls underwent task-related paradigms (picture-encoding and Stroop paradigms) and resting-state functional MRI (rsfMRI). Global cognitive performance was tested using the Raven's Matrices test and participants completed questionnaires for evaluating dissociation. Functional connectivity analysis on rsfMRI was based on seed regions extracted from task-related fMRI activation maps. Results The patients displayed a significantly lower cognitive performance and significantly higher dissociation scores. No significant differences were found between the picture-encoding and Stroop colour-naming activation maps between controls and patients with PNES. However, functional connectivity maps from the rsfMRI were statistically different. For PNES patients, stronger connectivity values between areas involved in emotion (insula), executive control (inferior frontal gyrus and parietal cortex) and movement (precentral sulcus) were observed, which were significantly associated with dissociation scores. Conclusion The abnormal, strong functional connectivity in PNES patients provides a neurophysiological correlate for the underlying psychoform and somatoform dissociation mechanism where emotion can influence executive control, resulting in altered motor function (eg, seizure-like episodes).
Keywords
TEMPORAL-LOBE EPILEPSY, LOCALIZATION-RELATED EPILEPSY, SOMATOFORM DISSOCIATION, CONVERSION DISORDER, WORKING-MEMORY, HYPNOSIS, INTERFERENCE, SYMPTOMS, TRAUMA, FMRI

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Chicago
van der Kruijs, Sylvie JM, Nynke MG Bodde, Maarten J Vaessen, Richard HC Lazeron, Kristl Vonck, Paul Boon, Paul AM Hofman, Walter H Backes, Albert P Aldenkamp, and Jacobus FA Jansen. 2012. “Functional Connectivity of Dissociation in Patients with Psychogenic Non-epileptic Seizures.” Journal of Neurology Neurosurgery and Psychiatry 83 (3): 239–247.
APA
van der Kruijs, S. J., Bodde, N. M., Vaessen, M. J., Lazeron, R. H., Vonck, K., Boon, P., Hofman, P. A., et al. (2012). Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 83(3), 239–247.
Vancouver
1.
van der Kruijs SJ, Bodde NM, Vaessen MJ, Lazeron RH, Vonck K, Boon P, et al. Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY. 2012;83(3):239–47.
MLA
van der Kruijs, Sylvie JM, Nynke MG Bodde, Maarten J Vaessen, et al. “Functional Connectivity of Dissociation in Patients with Psychogenic Non-epileptic Seizures.” JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY 83.3 (2012): 239–247. Print.
@article{3025038,
  abstract     = {Introduction Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures, but lack epileptiform brain activity. Instead, the cause is assumed to be psychogenic. An abnormal coping strategy may be exhibited by PNES patients, as indicated by their increased tendency to dissociate. Investigation of resting-state networks may reveal altered routes of information and emotion processing in PNES patients. The authors therefore investigated whether PNES patients differ from healthy controls in their resting-state functional connectivity characteristics and whether these connections are associated with the tendency to dissociate. 
Methods 11 PNES patients without psychiatric comorbidity and 12 healthy controls underwent task-related paradigms (picture-encoding and Stroop paradigms) and resting-state functional MRI (rsfMRI). Global cognitive performance was tested using the Raven's Matrices test and participants completed questionnaires for evaluating dissociation. Functional connectivity analysis on rsfMRI was based on seed regions extracted from task-related fMRI activation maps. 
Results The patients displayed a significantly lower cognitive performance and significantly higher dissociation scores. No significant differences were found between the picture-encoding and Stroop colour-naming activation maps between controls and patients with PNES. However, functional connectivity maps from the rsfMRI were statistically different. For PNES patients, stronger connectivity values between areas involved in emotion (insula), executive control (inferior frontal gyrus and parietal cortex) and movement (precentral sulcus) were observed, which were significantly associated with dissociation scores. 
Conclusion The abnormal, strong functional connectivity in PNES patients provides a neurophysiological correlate for the underlying psychoform and somatoform dissociation mechanism where emotion can influence executive control, resulting in altered motor function (eg, seizure-like episodes).},
  author       = {van der Kruijs, Sylvie JM and Bodde, Nynke MG and Vaessen, Maarten J and Lazeron, Richard HC and Vonck, Kristl and Boon, Paul and Hofman, Paul AM and Backes, Walter H and Aldenkamp, Albert P and Jansen, Jacobus FA},
  issn         = {0022-3050},
  journal      = {JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY},
  keyword      = {TEMPORAL-LOBE EPILEPSY,LOCALIZATION-RELATED EPILEPSY,SOMATOFORM DISSOCIATION,CONVERSION DISORDER,WORKING-MEMORY,HYPNOSIS,INTERFERENCE,SYMPTOMS,TRAUMA,FMRI},
  language     = {eng},
  number       = {3},
  pages        = {239--247},
  title        = {Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures},
  url          = {http://dx.doi.org/10.1136/jnnp-2011-300776},
  volume       = {83},
  year         = {2012},
}

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