Reduced microstructural white matter integrity is associated with the severity of physical symptoms in functional neurological disorder

IF 3.4 2区医学 Q2 NEUROIMAGING

Neuroimage-Clinical Pub Date : 2025-01-01 DOI:10.1016/j.nicl.2025.103791

Nicolas Gninenko , Eliane Müller , Selma Aybek

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引用次数: 0

Abstract

Background

Functional neurological disorder (FND) is linked to functional changes in brain networks without an underlying brain lesion. However, the dichotomy between functional and structural changes has been challenged by research suggesting that not only functional but also anatomical alterations in the gray and white matter may underlie a subset of symptoms. This study aimed to characterize white matter microstructural integrity and its association with patient-reported and clinician-rated physical symptoms’ severity in a large sample of FND patients.

Methods

Diffusion-weighted imaging data were collected from 85 FND patients with mixed symptoms and 75 healthy controls (HCs), together with illness duration, clinician-rated (S-FMDRS & CGI), and patient-reported (SF-36) symptom severity. Microstructural integrity was computed based on probabilistic tractography using the Desikan-Killiany parcellation.

Results

Compared to HCs, patients with FND presented widespread reduced microstructural integrity stemming from regions such as the right lateral orbitofrontal cortex, insula, putamen, and superior temporal regions. After adjusting for depression and anxiety, these differences were no longer significant. Within-group analysis revealed that reduced microstructural integrity, particularly in the left precuneus and left superior parietal cortex, was strongly correlated with both patient-reported and clinician-evaluated severity of physical symptoms in FND patients.

Conclusion

Patients with FND present widespread reduced microstructural integrity in the brain, predominantly originating from temporoparietal, paralimbic and associated regions involved in emotion regulation and body awareness. These changes seem to be partly explained by comorbid mood disorders and the severity of physical symptoms, suggesting a plasticity phenomenon rather than trait biomarkers, which warrants further investigation in longitudinal study designs.

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功能性神经障碍患者微结构白质完整性降低与躯体症状的严重程度相关

背景：功能性神经障碍（FND）与脑网络的功能改变有关，但没有潜在的脑损伤。然而，功能和结构变化之间的二分法受到了研究的挑战，研究表明，不仅功能改变，而且灰质和白质的解剖改变可能是部分症状的基础。本研究旨在描述大量FND患者白质微结构完整性及其与患者报告和临床评定的身体症状严重程度的关系。方法收集85例伴有混合症状的FND患者和75例健康对照（hc）的弥散加权成像资料，以及病程、临床评分(S-FMDRS &；CGI)和患者报告的（SF-36）症状严重程度。显微结构的完整性是基于使用Desikan-Killiany包封的概率示踪术计算的。结果与hcc相比，FND患者表现出广泛的显微结构完整性降低，其源于右侧外侧眶额皮质、脑岛、壳核和颞上区等区域。在调整了抑郁和焦虑因素后，这些差异不再显著。组内分析显示，FND患者显微结构完整性的降低，尤其是左侧楔前叶和左侧顶叶上皮层，与患者报告和临床评估的身体症状严重程度密切相关。结论FND患者普遍存在大脑微结构完整性降低，主要发生在涉及情绪调节和身体意识的颞顶叶、旁边缘及相关区域。这些变化似乎部分可以用共病性情绪障碍和身体症状的严重程度来解释，这表明这是一种可塑性现象，而不是特质性生物标志物，这需要在纵向研究设计中进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroimage-Clinical NEUROIMAGING-

CiteScore

7.50

自引率

4.80%

发文量

368

审稿时长

52 days

期刊介绍： NeuroImage: Clinical, a journal of diseases, disorders and syndromes involving the Nervous System, provides a vehicle for communicating important advances in the study of abnormal structure-function relationships of the human nervous system based on imaging. The focus of NeuroImage: Clinical is on defining changes to the brain associated with primary neurologic and psychiatric diseases and disorders of the nervous system as well as behavioral syndromes and developmental conditions. The main criterion for judging papers is the extent of scientific advancement in the understanding of the pathophysiologic mechanisms of diseases and disorders, in identification of functional models that link clinical signs and symptoms with brain function and in the creation of image based tools applicable to a broad range of clinical needs including diagnosis, monitoring and tracking of illness, predicting therapeutic response and development of new treatments. Papers dealing with structure and function in animal models will also be considered if they reveal mechanisms that can be readily translated to human conditions.