Weakened functional connectivity in patients with psychogenic non-epileptic seizures (PNES) converges on basal ganglia

Barzegaran, Elham; Carmeli, Cristian; Rossetti, Andrea O.; Frackowiak, R. S. J.; Knyazeva, Maria G.

doi:10.1136/jnnp-2014-309483

Cited by 34 publications

(59 citation statements)

References 36 publications

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“…In a cohort of 18 PNES and 18 healthy subjects, resting state high-density source EEG analyses showed that patients with PNES exhibited decreased functional connectivity between the basal ganglia and cortical regions, along with reduced interhemispheric connectivity across paralimbic regions. 53 In a unique case of intracranial recordings during PNES, decreased power in the theta band was observed over the posterior parietal cortex. 54 Several investigations have probed autonomic profiles peri-ictally in PNES 55 ; some noted increased sympathetic tone ictally in ES vs. PNES, 56 while others characterized pre-ictal and post-ictal autonomic changes as distinguishing between groups.…”

Section: The Emerging Neurobiology Of Pnesmentioning

confidence: 96%

Nonepileptic seizures: an updated review

2016

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Psychogenic nonepileptic seizures are a Functional Neurological Disorder/ Conversion Disorder subtype, which are neurobehavioral conditions at the interface of Neurology and Psychiatry. Significant advancements over the past decade have been made in the diagnosis, management and neurobiological understanding of PNES. This article reviews published PNES research focusing on semiologic features that distinguish PNES from epileptic seizures, consensus diagnostic criteria, the intersection of PNES and other comorbidities, neurobiological studies, evidence-based treatment interventions and outcome studies. Epidemiology and health care utilization studies highlight a continued unmet medical need in the comprehensive care of PNES. Consensus guidelines for diagnostic certainty are based on clinical history, semiology of witnessed typical event(s), and EEG findings. While certain semiologic features may aid the diagnosis of PNES, the gold standard remains capturing a typical event on video electroencephalography (EEG) showing the absence of epileptiform activity with history and semiology consistent with PNES. Medical-neurologic and psychiatric comorbidities are prevalent in PNES and should be assessed in diagnostic evaluations, and integrated into treatment interventions and prognostic considerations. Several studies, including a pilot multicenter, randomized clinical trial, have now demonstrated that a cognitive behavioral therapy informed psychotherapy is an efficacious treatment for PNES, and additional efforts are necessary to evaluate the utility of pharmacologic and other psychotherapy treatments. Neuroimaging studies, while requiring replication, suggest that PNES may occur in the context of alterations within and across sensorimotor, emotion regulation/processing, cognitive control and multimodal integration brain systems. Future research could investigate similarities and differences between PNES and other somatic symptom disorders.

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Section: The Emerging Neurobiology Of Pnesmentioning

confidence: 96%

Nonepileptic seizures: an updated review

2016

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“…Many of these studies reproduced similar findings. Findings from these imaging studies are also concordant with functional connectivity studies derived from resting-state high-density EEGs [6,19]. It remains unclear, however, whether the findings are specific to PNES, or instead may be tied to some of the commonly associated comorbidities seen in patients with PNES (e.g., depression, traumatic brain injury, etc.)…”

Section: Introductionmentioning

confidence: 55%

“…However, recent evidences, including advanced EEG and imaging techniques, reveal that patients have specific neurobiological dysfunctions, specifically functional and structural brain connectivity abnormalities [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. For example, functional imaging studies have shown evidence of altered functional and structural connectivity of brain networks in patients with PNES [20].…”

Section: Introductionmentioning

confidence: 99%

Biological underpinnings of psychogenic nonepileptic seizures: directions for future research

Asadi‐Pooya

2016

Neurol Sci

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Psychogenic nonepileptic seizures (PNES) are relatively common occurrences in epilepsy centers, but their pathophysiology is still poorly understood. Research that elucidates the pathophysiology of PNES, including their neurobiological basis and biomarkers, may have important clinical implications. The literature provides some evidence that genetic factors, intrinsic factors, and environmental factors probably play a significant role as the biological underpinnings of PNES. Researchers may be able to learn more about the pathophysiology of PNES by investigating the effects of each of these factors on functional and structural brain connectivity.

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“…In a nutshell, neurophysiological studies suggest that functional failures of executive control circuitry reflect alterations in connectivity in resting-state brain networks involved in the following: emotion regulation and arousal, cognitive control, self-referential processing, and motor planning and coordination. Studies in adults and adolescents show that functional failures also include changes in EEG synchrony, both within cortical brain systems and between cortical and subcortical brain systems ( Barzegaran, Carmeli, Rossetti, Frackowiak, & Knyazeva, 2016 ; Umesh, Tikka, Goyal, Sinha, & Nizamie, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

“…An unwanted by-product of this process may be the emergence of functional neurological motor symptoms, including PNES. Whereas functional motor symptoms, both positive and negative (abnormal gait, functional tremor, functional tics, motor weakness and limb paresis), appear to reflect a relatively stable reorganization of neural networks in response to stress, PNES appear to reflect transient disruptions of neural networks – disruptions that affect the vertical integration of brain function and that cause a disconnect between cortical and subcortical systems ( Barzegaran et al, 2016 ). The result is a temporary ‘glitch’ in top-down executive control over the motor regions in a time-limited release of motor programmes in the basal ganglia, midbrain and brain (PNES).…”

Section: Introductionmentioning

confidence: 99%

Psychogenic non-epileptic seizures in children and adolescents: Part I – Diagnostic formulations

Kozlowska

Chudleigh

Cruz

et al. 2017

Clin Child Psychol Psychiatry

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Psychogenic non-epileptic seizures (PNES) are a nonspecific, umbrella category that is used to collect together a range of atypical neurophysiological responses to emotional distress, physiological stressors and danger. Because PNES mimic epileptic seizures, children and adolescents with PNES usually present to neurologists or to epilepsy monitoring units. After a comprehensive neurological evaluation and a diagnosis of PNES, the patient is referred to mental health services for treatment. This study documents the diagnostic formulations – the clinical formulations about the probable neurophysiological mechanisms – that were constructed for 60 consecutive children and adolescents with PNES who were referred to our Mind-Body Rehabilitation Programme for treatment. As a heuristic framework, we used a contemporary reworking of Janet’s dissociation model: PNES occur in the context of a destabilized neural system and reflect a release of prewired motor programmes following a functional failure in cognitive-emotional executive control circuitry. Using this framework, we clustered the 60 patients into six different subgroups: (1) dissociative PNES (23/60; 38%), (2) dissociative PNES triggered by hyperventilation (32/60; 53%), (3) innate defence responses presenting as PNES (6/60; 10%), (4) PNES triggered by vocal cord adduction (1/60; 2%), (5) PNES triggered by activation of the valsalva manoeuvre (1/60; 1.5%) and (6) PNES triggered by reflex activation of the vagus (2/60; 3%). As described in the companion article, these diagnostic formulations were used, in turn, both to inform the explanations of PNES that we gave to families and to design clinical interventions for helping the children and adolescents gain control of their PNES.

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Weakened functional connectivity in patients with psychogenic non-epileptic seizures (PNES) converges on basal ganglia

Cited by 34 publications

References 36 publications

Nonepileptic seizures: an updated review

Nonepileptic seizures: an updated review

Biological underpinnings of psychogenic nonepileptic seizures: directions for future research

Psychogenic non-epileptic seizures in children and adolescents: Part I – Diagnostic formulations

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