Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls

Wesley T Kerr; Hiroyuki Tatekawa; John K Lee; Amir H Karimi; Siddhika S Sreenivasan; Joseph O'Neill; Jena M Smith; L Brian Hickman; Ivanka Savic; Nilab Nasrullah; Randall Espinoza; Katherine Narr; Noriko Salamon; Nicholas J Beimer; Lubomir M Hadjiiski; Dawn S Eliashiv; William C Stacey; Jerome Engel Jr; Jamie D Feusner; John M Stern

doi:10.1016/j.yebeh.2022.108858

Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls

Epilepsy Behav. 2022 Sep:134:108858. doi: 10.1016/j.yebeh.2022.108858. Epub 2022 Aug 4.

Authors

Wesley T Kerr¹, Hiroyuki Tatekawa², John K Lee³, Amir H Karimi⁴, Siddhika S Sreenivasan⁴, Joseph O'Neill⁵, Jena M Smith³, L Brian Hickman³, Ivanka Savic⁶, Nilab Nasrullah⁶, Randall Espinoza⁷, Katherine Narr⁷, Noriko Salamon², Nicholas J Beimer⁸, Lubomir M Hadjiiski⁹, Dawn S Eliashiv³, William C Stacey¹⁰, Jerome Engel Jr¹¹, Jamie D Feusner¹², John M Stern³

Affiliations

¹ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: KerrWe@Med.UMich.edu.
² Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
³ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁴ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
⁵ Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA.
⁶ Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden.
⁷ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
⁸ Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
⁹ Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
¹¹ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹² Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.

PMID: 35933959
DOI: 10.1016/j.yebeh.2022.108858

Abstract

Purpose: Functional seizures (FS), also known as psychogenic nonepileptic seizures (PNES), are physical manifestations of acute or chronic psychological distress. Functional and structural neuroimaging have identified objective signs of this disorder. We evaluated whether magnetic resonance imaging (MRI) morphometry differed between patients with FS and clinically relevant comparison populations.

Methods: Quality-screened clinical-grade MRIs were acquired from 666 patients from 2006 to 2020. Morphometric features were quantified with FreeSurfer v6. Mixed-effects linear regression compared the volume, thickness, and surface area within 201 regions-of-interest for 90 patients with FS, compared to seizure-naïve patients with depression (n = 243), anxiety (n = 68), and obsessive-compulsive disorder (OCD, n = 41), respectively, and to other seizure-naïve controls with similar quality MRIs, accounting for the influence of multiple confounds including depression and anxiety based on chart review. These comparison populations were obtained through review of clinical records plus research studies obtained on similar scanners.

Results: After Bonferroni-Holm correction, patients with FS compared with seizure-naïve controls exhibited thinner bilateral superior temporal cortex (left 0.053 mm, p = 0.014; right 0.071 mm, p = 0.00006), thicker left lateral occipital cortex (0.052 mm, p = 0.0035), and greater left cerebellar white-matter volume (1085 mm³, p = 0.0065). These findings were not accounted for by lower MRI quality in patients with FS.

Conclusions: These results reinforce prior indications of structural neuroimaging correlates of FS and, in particular, distinguish brain morphology in FS from that in depression, anxiety, and OCD. Future work may entail comparisons with other psychiatric disorders including bipolar and schizophrenia, as well as exploration of brain structural heterogeneity within FS.

Keywords: Brain morphology; Conversion disorder; Dissociative seizures; Morphometry; Pseudoseizures.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Brain
Humans
Magnetic Resonance Imaging*
Neuroimaging
Obsessive-Compulsive Disorder*
Seizures

Abstract

Publication types

MeSH terms

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