FMRI response to acute psychological stress differentiates patients with psychogenic non-epileptic seizures from healthy controls - A biochemical and neuroimaging biomarker study

Jane B Allendorfer; Rodolphe Nenert; Kathleen A Hernando; Jennifer L DeWolfe; Sandipan Pati; Ashley E Thomas; Neil Billeaud; Roy C Martin; Jerzy P Szaflarski

doi:10.1016/j.nicl.2019.101967

FMRI response to acute psychological stress differentiates patients with psychogenic non-epileptic seizures from healthy controls - A biochemical and neuroimaging biomarker study

Neuroimage Clin. 2019:24:101967. doi: 10.1016/j.nicl.2019.101967. Epub 2019 Aug 6.

Authors

Jane B Allendorfer¹, Rodolphe Nenert², Kathleen A Hernando², Jennifer L DeWolfe², Sandipan Pati², Ashley E Thomas², Neil Billeaud², Roy C Martin², Jerzy P Szaflarski³

Affiliations

¹ Department of Neurology, The UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: jallendorfer@uabmc.edu.
² Department of Neurology, The UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Department of Neurology, The UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

We investigated psychological stress response in the brain regions involved in emotion-motor-executive control in psychogenic non-epileptic seizures (PNES). 12 PNES patients and 12 healthy controls (HCs) underwent stress task and resting state functional MRI (fMRI), mood and quality of life (QOL) assessments, and measurements of salivary cortisol, alpha-amylase, and heart rate. Group differences were assessed, and we correlated beta values from a priori selected brain regions showing stress task fMRI group differences with other stress response measures. We also used the regions showing stress task fMRI group differences as seeds for resting state functional connectivity (rs-FC) analysis. Mood and QOL were worse in PNES versus HCs. Physiological and assessment measures were similar except 'Planful Problem Solving' coping that was greater for HCs (p = .043). Perceived stress associated negatively with heart rate change (r_s = -0.74, p = .0063). There was stress fMRI hyporeactivity in left/right amygdala and left hippocampus in PNES versus HCs (corrected p < .05). PNES exhibited a positive association between alpha-amylase change and right amygdala activation (r_s = 0.71, p = .010). PNES versus HCs exhibited greater right amygdala rs-FC to left precentral and inferior/middle frontal gyri (corrected p < .05). Our findings of fMRI hyporeactivity to psychological stress, along with greater emotion-motor-executive control network rs-FC in PNES when compared to HCs suggest a dysregulation in stress response circuitry in PNES.

Keywords: Alpha-amylase; Cortisol; Emotion; Psychogenic non-epileptic seizures (PNES); Psychological stress; fMRI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neuroimaging / methods*
Seizures / diagnostic imaging*
Seizures / physiopathology*
Stress, Psychological / diagnostic imaging*
Stress, Psychological / physiopathology*