BMJ Neurology Open最新文献

{"title":"Virtual reality in functional neurological disorder: a theoretical framework and research agenda for use in the real world","authors":"David Brouwer, Hamilton Morrin, Timothy R Nicholson, Devin B Terhune, Michelle Schrijnemaekers, Mark J Edwards, Jeannette Gelauff, Paul Shotbolt","doi":"10.1136/bmjno-2023-000622","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000622","url":null,"abstract":"Functional neurological disorder (FND) is a common and disabling condition at the intersection of neurology and psychiatry. Despite remarkable progress over recent decades, the mechanisms of FND are still poorly understood and there are limited diagnostic tools and effective treatments. One potentially promising treatment modality for FND is virtual reality (VR), which has been increasingly applied to a broad range of conditions, including neuropsychiatric disorders. FND has unique features, many of which suggest the particular relevance for, and potential efficacy of, VR in both better understanding and managing the disorder. In this review, we describe how VR might be leveraged in the treatment and diagnosis of FND (with a primary focus on motor FND and persistent perceptual-postural dizziness given their prominence in the literature), as well as the elucidation of neurocognitive mechanisms and symptom phenomenology. First, we review what has been published to date on the applications of VR in FND and related neuropsychiatric disorders. We then discuss the hypothesised mechanism(s) underlying FND, focusing on the features that are most relevant to VR applications. Finally, we discuss the potential of VR in (1) advancing mechanistic understanding, focusing specifically on sense of agency, attention and suggestibility, (2) overcoming diagnostic challenges and (3) developing novel treatment modalities. This review aims to develop a theoretical foundation and research agenda for the use of VR in FND that might be applicable or adaptable to other related disorders.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"24 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141551162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attending system for acute neurology care: experience in a UK centre","authors":"Alex Gordon, Daniel Lashley, Martin Sadler, Simon Edwards, Azlisham Mohd Nor, Elizabeth Househam, Alex Shah, Michael O’Gara, Eiman Abdelgadir, Omar Al Masri, Ginette Crossingham, Stephen Mullin, Stuart Weatherby","doi":"10.1136/bmjno-2023-000625","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000625","url":null,"abstract":"Acute neurology makes up 10%–20% of the acute medical take in UK hospitals.[1][1] Despite this, almost two-thirds of patients with acute neurological problems in the UK are admitted to hospitals without any neurology inpatient beds.[2][2] Getting It Right First Time (GIRFT) is a national","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"28 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141754010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classifying and quantifying changes in papilloedema using machine learning.","authors":"Joseph Branco, Jui-Kai Wang, Tobias Elze, Mona K Garvin, Louis R Pasquale, Randy Kardon, Brian Woods, David Szanto, Mark J Kupersmith","doi":"10.1136/bmjno-2023-000503","DOIUrl":"10.1136/bmjno-2023-000503","url":null,"abstract":"<p><strong>Background: </strong>Machine learning (ML) can differentiate papilloedema from normal optic discs using fundus photos. Currently, papilloedema severity is assessed using the descriptive, ordinal Frisén scale. We hypothesise that ML can quantify papilloedema and detect a treatment effect on papilloedema due to idiopathic intracranial hypertension.</p><p><strong>Methods: </strong>We trained a convolutional neural network to assign a Frisén grade to fundus photos taken from the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). We applied modified subject-based fivefold cross-validation to grade 2979 longitudinal images from 158 participants' study eyes (ie, the eye with the worst mean deviation) in the IIHTT. Compared with the human expert-determined grades, we hypothesise that ML-estimated grades can also demonstrate differential changes over time in the IIHTT study eyes between the treatment (acetazolamide (ACZ) plus diet) and placebo (diet only) groups.</p><p><strong>Findings: </strong>The average ML-determined grade correlated strongly with the reference standard (r=0.76, p<0.001; mean absolute error=0.54). At the presentation, treatment groups had similar expert-determined and ML-determined Frisén grades. The average ML-determined grade for the ACZ group (1.7, 95% CI 1.5 to 1.8) was significantly lower (p=0.0003) than for the placebo group (2.3, 95% CI 2.0 to 2.5) at the 6-month trial outcome.</p><p><strong>Interpretation: </strong>Supervised ML of fundus photos quantified the degree of papilloedema and changes over time reflecting the effects of ACZ. Given the increasing availability of fundus photography, neurologists will be able to use ML to quantify papilloedema on a continuous scale that incorporates the features of the Frisén grade to monitor interventions.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000503"},"PeriodicalIF":2.1,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictions for functional outcome and mortality in acute ischaemic stroke following successful endovascular thrombectomy.","authors":"Minyan Zeng, Luke Smith, Alix Bird, Vincent Quoc-Nam Trinh, Stephen Bacchi, Jackson Harvey, Mark Jenkinson, Rebecca Scroop, Timothy Kleinig, Jim Jannes, Lyle J Palmer","doi":"10.1136/bmjno-2024-000707","DOIUrl":"10.1136/bmjno-2024-000707","url":null,"abstract":"<p><strong>Background: </strong>Accurate outcome predictions for patients who had ischaemic stroke with successful reperfusion after endovascular thrombectomy (EVT) may improve patient treatment and care. Our study developed prediction models for key clinical outcomes in patients with successful reperfusion following EVT in an Australian population.</p><p><strong>Methods: </strong>The study included all patients who had ischaemic stroke with occlusion in the proximal anterior cerebral circulation and successful reperfusion post-EVT over a 7-year period. Multivariable logistic regression and Cox regression models, incorporating bootstrap and multiple imputation techniques, were used to identify predictors and develop models for key clinical outcomes: 3-month poor functional status; 30-day, 1-year and 3-year mortality; survival time.</p><p><strong>Results: </strong>A total of 978 patients were included in the analyses. Predictors associated with one or more poor outcomes include: older age (ORs for every 5-year increase: 1.22-1.40), higher premorbid functional modified Rankin Scale (ORs: 1.31-1.75), higher baseline National Institutes of Health Stroke Scale (ORs: 1.05-1.07) score, higher blood glucose (ORs: 1.08-1.19), larger core volume (ORs for every 10 mL increase: 1.10-1.22), pre-EVT thrombolytic therapy (ORs: 0.44-0.56), history of heart failure (outcome: 30-day mortality, OR=1.87), interhospital transfer (ORs: 1.42 to 1.53), non-rural/regional stroke onset (outcome: functional dependency, OR=0.64), longer onset-to-groin puncture time (outcome: 3-year mortality, OR=1.08) and atherosclerosis-caused stroke (outcome: functional dependency, OR=1.68). The models using these predictors demonstrated moderate predictive abilities (area under the receiver operating characteristic curve range: 0.752-0.796).</p><p><strong>Conclusion: </strong>Our models using real-world predictors assessed at hospital admission showed satisfactory performance in predicting poor functional outcomes and short-term and long-term mortality for patients with successful reperfusion following EVT. These can be used to inform EVT treatment provision and consent.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000707"},"PeriodicalIF":2.1,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11202712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planned dose reduction of ocrelizumab in relapsing-remitting multiple sclerosis: a single-centre observational study.","authors":"Trung Dang Quoc Tran, Leanne Hall, Clare Heal, Nagaraja Haleagrahara, Sharon Edwards, Mike Boggild","doi":"10.1136/bmjno-2024-000672","DOIUrl":"10.1136/bmjno-2024-000672","url":null,"abstract":"<p><strong>Background: </strong>Ocrelizumab, a humanised anti-CD20 monoclonal, is a highly effective treatment for relapsing-remitting multiple sclerosis (RRMS). The long-term safety of B-cell depletion in RRMS, however, is uncertain and there are no data on dose reduction of ocrelizumab as a risk mitigation strategy. This study aimed to evaluate the effectiveness and safety of reducing ocrelizumab dose from 600 to 300 mg in patients with RRMS.</p><p><strong>Method: </strong>Data were collected through the Townsville neurology service. Following the standard randomised controlled trial regimen of 600 mg every 6 months for 2 years, sequential patients consented to dose reduction to 300 mg every 6 months. Patients were included if they were diagnosed with RRMS and received at least one reduced dose of ocrelizumab. Relapse, disability progression, new MRI lesions, CD19⁺ cell counts and immunoglobulin concentrations were analysed.</p><p><strong>Results: </strong>A total of 35 patients, treated with 177 full and 107 reduced doses, were included. The mean follow-up on reduced dose was 17 (1-31) months. We observed no relapses or new MRI activity in the cohort receiving the reduced dose, accompanied by persistent CD19+B cell depletion (≤0.05×10⁹/L). Mean IgG, IgA and IgM levels remained stable throughout the study. No new safety concerns arose.</p><p><strong>Conclusions: </strong>In this single-centre observational study, dose reduction of ocrelizumab from 600 to 300 mg every 6 months after 2 years appeared to maintain efficacy in terms of new inflammatory disease activity. A randomised trial may be warranted to confirm this and explore the impact of dose reduction on long-term safety.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000672"},"PeriodicalIF":2.1,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel de novo heterozygous CACNA1A gene variant in generalised dystonia: a case report.","authors":"Mohammed Alshareet, Aljoharah Alakkas, Omar A Alsinaidi, Shahad Bawazeer, Abdul Ali Peer-Zada","doi":"10.1136/bmjno-2024-000710","DOIUrl":"10.1136/bmjno-2024-000710","url":null,"abstract":"<p><strong>Background: </strong>Dystonia is a genetic or non-genetic movement disorder with typical patterned and twisting movements due to abnormal muscle contractions that may be associated with tremor. Genetic and phenotypic heterogeneity leads to variable clinical presentation.</p><p><strong>Methodology: </strong>Next-generation sequencing technologies are being currently used in the workup of patients with inherited dystonia to determine the specific cause in the individuals with autosomal dominant, recessive, X-linked or mitochondrial inheritance patterns. Calcium voltage-gated channel subunit alpha1 A (CACNA1A) gene variants are rare in dystonias.</p><p><strong>Results: </strong>We here present a 20-year-old man with a history of delayed milestones, flexor posturing, dysarthria, dysphagia and a negative family history from consanguineous parents. Neurological examination revealed right lateral scoliosis of the neck and generalised dystonic posturing affecting both upper and lower limbs. MRI of the brain was unremarkable. Molecular genetic results revealed a heterozygous variant in the CACNA1A gene (CHR19: NM_023035.2, c. 1602G>A; p. Met534Ile). Segregation analyses in both the parents revealed wild-type CACNA1A gene suggesting de novo nature of the variant with a likely pathogenic classification.</p><p><strong>Conclusion: </strong>Dystonia is one of the clinical phenotypes that can be associated with CACNA1A gene mutations and we recommend that this gene either be included in the dystonia panel offered or tested when the initial primary genetic result is negative.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000710"},"PeriodicalIF":2.1,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Grasshopper sign': the novel imaging of post-COVID-19 myelopathy with delayed longitudinal white matter abnormalities.","authors":"Motohiro Okumura, Kazumasa Sekiguchi, Tomoko Okamoto, Reiko Saika, Hiroyuki Maki, Wakiro Sato, Noriko Sato, Takashi Yamamura, Yuji Takahashi","doi":"10.1136/bmjno-2024-000730","DOIUrl":"10.1136/bmjno-2024-000730","url":null,"abstract":"<p><strong>Introduction: </strong>Recently, there have been a few reports of atypical post-coronavirus disease 2019 (COVID-19) myelopathy manifesting tract-specific lesions similar to those due to vitamin B₁₂ deficiency. However, the precise characteristics of imaging or clinical course remain not well understood.</p><p><strong>Methods: </strong>A retrospective analysis of the clinical and imaging characteristics of four patients who were referred to our hospital with a unique post-COVID-19 myelopathy was performed.</p><p><strong>Results: </strong>Four-to-six weeks following COVID-19 infection in the summer of 2023, four middle-aged men developed paraparesis, hypo/dysesthesia and bladder/bowel disturbance, suggesting myelopathy. Although spinal MRI showed no abnormalities in the early stages, tract-specific longitudinal lesions along the dorsal and lateral columns became apparent as the symptoms progressed. Owing to the lack of MRI findings at the early stage, all cases were challenging to diagnose. However, the patients remained partially responsive to aggressive immunosuppressive therapies, even in the advanced stage.</p><p><strong>Discussion: </strong>We termed these tract-specific longitudinal lesions in the presented case series 'Grasshopper sign' because brain coronal and spine axial MRI findings looked like a grasshopper's antennae and face. Early identification of the characteristic MRI abnormality could allow for early intervention using intensive immunosuppressive therapy, which could improve patient outcomes.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000730"},"PeriodicalIF":2.7,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11177679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical drivers of hospitalisation in patients with mitochondrial diseases.","authors":"Sameen Haque, Karen Crawley, Ryan Davis, Deborah Schofield, Rupendra Shrestha, Carolyn M Sue","doi":"10.1136/bmjno-2024-000717","DOIUrl":"10.1136/bmjno-2024-000717","url":null,"abstract":"<p><strong>Background: </strong>Mitochondrial diseases in adults are generally chronic conditions with a wide spectrum of severity contributing to disease burden and healthcare resource utilisation. Data on healthcare resource utilisation in mitochondrial diseases are limited.</p><p><strong>Objectives: </strong>We performed a retrospective longitudinal study to investigate the clinical drivers of hospitalisation in adult patients with mitochondrial diseases to better understand healthcare resource utilisation.</p><p><strong>Methods: </strong>We recruited participants from our specialised Mitochondrial Disease Clinic in Sydney, Australia between September 2018 and December 2021. We performed a retrospective chart review for the period 2013-2022 considering emergency department (ED) and/or hospital admission notes, as well as discharge summaries. We used multiple linear regression models to examine the association between the type of presenting symptom(s) and duration of hospital stay and frequency of admissions, while adjusting for relevant covariates.</p><p><strong>Results: </strong>Of the 99 patients considered, the duration of hospitalisation ranged from 0 to 116 days per participant and the number of admissions ranged from 0 to 21 per participant. Participants with one or more mitochondrial disease-associated admissions constituted 52% of the study cohort. 13% of the participants presented to the ED without requiring an admission and 35% never attended the ED or required a hospital admission during this period. Neurological (p<i><</i>0.0001), gastroenterological (p=0.01) and symptoms categorised as 'other' (p<i><</i>0.0001) were the main presentations driving the total number of days admitted to hospital. A statistically significant association was evident for the number of admissions and all types of presenting symptoms (p<i><</i>0.0001).</p><p><strong>Conclusion: </strong>There are variable reasons for hospitalisation in adults with mitochondrial diseases, with neurological and gastroenterological presentations being associated with prolonged and complex hospitalisation. A better understanding of clinical drivers such as these allows for better informed and well-coordinated management aimed at optimising healthcare resource utilisation.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000717"},"PeriodicalIF":2.7,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11168164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Illness perceptions, experiences of stigma and engagement in functional neurological disorder (FND): exploring the role of multidisciplinary group education sessions.","authors":"Cate Bailey, Niruj Agrawal, Sarah Cope, Barnaby Proctor, Bridget Mildon, Matt Butler, Kate Holt, Mark Edwards, Norman Poole, Timothy R Nicholson","doi":"10.1136/bmjno-2024-000633","DOIUrl":"10.1136/bmjno-2024-000633","url":null,"abstract":"<p><strong>Background: </strong>A critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model. Multidisciplinary group education sessions are one way to achieve this, with some evidence they improve understanding, confidence in diagnosis and outcomes with further treatment. In many conditions, illness perceptions and stigma affect distress, functioning, quality of life and engagement. Exploring relationships between these factors could lead to deeper understanding of the impact of education.</p><p><strong>Methods: </strong>Questionnaires assessing illness perceptions, quality of life, mood, anxiety, comorbidities, treatment engagement and stigma (both experienced and anticipated) were completed before, immediately and 1 month after a multidisciplinary online group education session for FND at a regional neurosciences centre. Free-text data on causal attributions and needs were also collected.</p><p><strong>Results: </strong>166 patients attended online education sessions from January 2022 to July 2023; 61 (37%) completed presession surveys, 42 (25%) completed postsession and 35 (21%) completed 1 month postsession surveys. Patients reported multiple comorbidities, poor quality of life, functioning and high levels of stigma. Illness perception scores indicated FND as threatening, mysterious and unpredictable, with low personal or treatment control over symptoms. Illness coherence/understanding (mean difference 2.27, p<0.01, 95% CI 1.22 to 4.23) and engagement (mean difference 2.42, p<0.01, 95% CI 0.46 to 4.36) increased after the session. There were no significant changes in stigma, distress, sense of control or anticipated discrimination. Free-text analysis revealed stress and trauma as the most common causal attributions, followed by physical illnesses. Patients requested personalised formulations, practical disability advice, help with explaining the condition to others (eg, employers), peer support and treatment.</p><p><strong>Conclusion: </strong>Multidisciplinary group FND education sessions potentially improve patient understanding and engagement. Clinicians should consider the possible benefits of personalised formulations and linking to practical and peer support. Further work assessing illness perceptions is needed, such as adapting measures for FND.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000633"},"PeriodicalIF":2.7,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heartbeat evoked potentials and autonomic arousal during dissociative seizures: insights from electrophysiology and neuroimaging.","authors":"Vera Flasbeck, Johannes Jungilligens, Isabell Lemke, Jule Beckers, Hilal Öztürk, Jörg Wellmer, Corinna Seliger, Georg Juckel, Stoyan Popkirov","doi":"10.1136/bmjno-2024-000665","DOIUrl":"10.1136/bmjno-2024-000665","url":null,"abstract":"<p><strong>Introduction: </strong>Dissociative seizures often occur in the context of dysregulated affective arousal and entail dissociative symptoms such as a disintegration of bodily awareness. However, the interplay between affective arousal and changes in interoceptive processing at the onset of dissociative seizures is not well understood.</p><p><strong>Methods: </strong>Using retrospective routine data obtained from video-electroencephalography telemetry in a university hospital epilepsy monitoring unit, we investigate ictal changes in cardiac indices of autonomic arousal and heartbeat evoked potentials (HEPs) in 24 patients with dissociative seizures.</p><p><strong>Results: </strong>Results show autonomic arousal during seizures with increased heart rate and a shift towards sympathetic activity. Compared with baseline, ictal HEP amplitudes over central and right prefrontal electrodes (F8, Fz) were significantly less pronounced during seizures, suggesting diminished cortical representation of interoceptive information. Significant correlations between heart rate variability measures and HEPs were observed at baseline, with more sympathetic and less parasympathetic activity related to less pronounced HEPs. Interestingly, these relationships weakened during seizures, suggesting a disintegration of autonomic arousal and interoceptive processing during dissociative seizures. In a subgroup of 16 patients, MRI-based cortical thickness analysis found a correlation with HEP amplitudes in the left somatosensory association cortex.</p><p><strong>Conclusions: </strong>These findings possibly represent an electrophysiological hint of how autonomic arousal could negatively impact bodily awareness in dissociative seizures, and how these processes might be related to underlying brain structure.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000665"},"PeriodicalIF":2.7,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}