背景:功能性神经障碍(FND)是一种常见的神经精神疾病,具有既定的诊断标准和有效的治疗方法,但其潜在的神经病理生理机制仍未完全了解。最近的神经影像学研究表明,FND是一种多网络脑部疾病,在边缘揭幕,自我代理,注意力/显着性,和感觉运动网络。然而,已识别的大脑改变与疾病进展或改善之间的关系研究较少。
方法:本研究包括79例FND患者和74例年龄和性别匹配的健康对照者(HC)的静息状态功能磁共振成像(fMRI)数据。首先,计算每个参与者的逐体素BOLD信号变异性,并计算逐组差异.第二,我们在8个月后参加随访测量的47例患者中,研究了BOLD信号变异性作为临床结局预后生物标志物的潜力.
结果:结果显示关键网络中的BOLD信号变异性更高,包括躯体运动,显著性,边缘,和背侧注意力网络,与对照组相比,患者。纵向分析显示,在有改善临床结果的FND患者中,辅助运动区(SMA)的BOLD信号变异性增加,提示SMA变异性是一种潜在的状态生物标志物。此外,基线时左侧脑岛BOLD信号变异性越高,预测临床结局越差.
结论:这项研究有助于了解FND的病理生理学,强调神经活动的动态性质,并强调BOLD信号变异性作为有价值的研究工具的潜力。脑岛和SMA作为有希望的区域出现,可作为预后和状态标志物进行进一步研究。
BACKGROUND: Functional neurological disorder (FND) is a common neuropsychiatric condition with established diagnostic criteria and effective treatments but for which the underlying neuropathophysiological mechanisms remain incompletely understood. Recent neuroimaging studies have revealed FND as a multi-network brain disorder, unveiling alterations across limbic, self-agency, attentional/salience, and sensorimotor networks. However, the relationship between identified brain alterations and disease progression or improvement is less explored.
METHODS: This study included resting-state functional magnetic resonance imaging (fMRI) data from 79 patients with FND and 74 age and sex-matched healthy controls (HC). First, voxel-wise BOLD signal variability was computed for each participant and the group-wise difference was calculated. Second, we investigated the potential of BOLD signal variability to serve as a prognostic biomarker for clinical outcome in 47 patients who attended a follow-up measurement after eight months.
RESULTS: The results demonstrated higher BOLD signal variability in key networks, including the somatomotor, salience, limbic, and dorsal attention networks, in patients compared to controls. Longitudinal analysis revealed an increase in BOLD signal variability in the supplementary motor area (SMA) in FND patients who had an improved clinical outcome, suggesting SMA variability as a potential state biomarker. Additionally, higher BOLD signal variability in the left insula at baseline predicted a worse clinical outcome.
CONCLUSIONS: This study contributes to the understanding of FND pathophysiology, emphasizing the dynamic nature of neural activity and highlighting the potential of BOLD signal variability as a valuable research tool. The insula and SMA emerge as promising regions for further investigation as prognostic and state markers.