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

S.J.M. van der Kruijs, N.M.G Bodde, M.J. Vaessen, R.H.C. Lazeron, K. Vonck, P. Boon, P.A.M. Hofman, W.H. Backes, A.P. Aldenkamp, J.F.A. Jansen

    Research output: Contribution to journalArticleAcademicpeer-review

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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 colournaming 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).

    Original languageEnglish
    Pages (from-to)239-247
    Number of pages9
    JournalJournal of Neurology, Neurosurgery & Psychiatry
    Volume83
    Issue number3
    DOIs
    Publication statusPublished - Mar 2012

    Fingerprint

    Seizures
    Magnetic Resonance Imaging
    Emotions
    Executive Function
    Stroop Test
    Connectivity
    Dissociation
    Crows
    Parietal Lobe
    Frontal Lobe
    Prefrontal Cortex
    Automatic Data Processing
    Psychiatry
    Comorbidity
    Epilepsy
    Seeds
    Brain
    Emotion
    Functional MRI

    Cite this

    van der Kruijs, S.J.M. ; Bodde, N.M.G ; Vaessen, M.J. ; Lazeron, R.H.C. ; Vonck, K. ; Boon, P. ; Hofman, P.A.M. ; Backes, W.H. ; Aldenkamp, A.P. ; Jansen, J.F.A. / Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. In: Journal of Neurology, Neurosurgery & Psychiatry. 2012 ; Vol. 83, No. 3. pp. 239-247.
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    title = "Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures",
    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 colournaming 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}, S.J.M. and N.M.G Bodde and M.J. Vaessen and R.H.C. Lazeron and K. Vonck and P. Boon and P.A.M. Hofman and W.H. Backes and A.P. Aldenkamp and J.F.A. Jansen",
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    Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. / van der Kruijs, S.J.M.; Bodde, N.M.G; Vaessen, M.J.; Lazeron, R.H.C.; Vonck, K.; Boon, P.; Hofman, P.A.M.; Backes, W.H.; Aldenkamp, A.P.; Jansen, J.F.A.

    In: Journal of Neurology, Neurosurgery & Psychiatry, Vol. 83, No. 3, 03.2012, p. 239-247.

    Research output: Contribution to journalArticleAcademicpeer-review

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    T1 - Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures

    AU - van der Kruijs, S.J.M.

    AU - Bodde, N.M.G

    AU - Vaessen, M.J.

    AU - Lazeron, R.H.C.

    AU - Vonck, K.

    AU - Boon, P.

    AU - Hofman, P.A.M.

    AU - Backes, W.H.

    AU - Aldenkamp, A.P.

    AU - Jansen, J.F.A.

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    N2 - 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 colournaming 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).

    AB - 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 colournaming 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).

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