Resting cortical PET metabolic changes in psychogenic non-epileptic seizures (PNES)

M Arthuis, J A Micoulaud-Franchi, F Bartolomei, Aileen McGonigal, E Guedj
J Neurol Neurosurg Psychiatry. 2014-12-02; 86(10): 1106-1112
DOI: 10.1136/jnnp-2014-309390

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1. J Neurol Neurosurg Psychiatry. 2015 Oct;86(10):1106-12. doi:
10.1136/jnnp-2014-309390. Epub 2014 Dec 2.

Resting cortical PET metabolic changes in psychogenic non-epileptic seizures
(PNES).

Arthuis M(1), Micoulaud-Franchi JA(2), Bartolomei F(3), McGonigal A(3), Guedj
E(4).

Author information:
(1)Service de Neurophysiologie Clinique, Hôpital de la Timone, Assistance
Publique des Hôpitaux de Marseille, Marseille, France Pôle de Psychiatrie, Centre
Hospitalier Universitaire de Sainte-Marguerite, Marseille, France.
(2)Pôle de Psychiatrie, Centre Hospitalier Universitaire de Sainte-Marguerite,
Marseille, France.
(3)Service de Neurophysiologie Clinique, Hôpital de la Timone, Assistance
Publique des Hôpitaux de Marseille, Marseille, France Institut de Neurosciences
des Systèmes, INSERM UMR 1106, Marseille, France Aix Marseille Université,
Faculté de Médecine, Marseille, France.
(4)Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone,
Assistance Publique des Hôpitaux de Marseille, Marseille, France Aix-Marseille
Université, CERIMED, Marseille, France Aix-Marseille Université, CNRS, UMR7289,
INT, Marseille, France.

BACKGROUND: The pathophysiology of psychogenic non-epileptic seizures (PNES) is
poorly understood. Functional neuroimaging data in various functional
neurological disorders increasingly support specific neurobiological dysfunction.
However, to date, no studies have been reported of positron emission tomography
(PET) in patients presenting with PNES.
METHODS: Sixteen patients being evaluated in a specialist epilepsy centre
underwent PET with 2-deoxy-2-[fluorine-18]fluoro-d-glucose ((18)FDG-PET) because
of suspected intractable epileptic seizures. However, in all patients, the
diagnosis was subsequently confirmed to be PNES with no coexisting epilepsy.
(18)FDG-PET was also performed in 16 healthy controls. A voxel by voxel
intergroup analysis was performed to look for significant differences in
interictal (resting state) cerebral metabolism. In addition, metabolic
connectivity was studied using voxel-wise inter-regional correlation analysis.
RESULTS: In comparison to group analysis of healthy participants, the group
analysis of patients with PNES exhibited significant PET hypometabolism within
the right inferior parietal and central region, and within the bilateral anterior
cingulate cortex. A significant increase in metabolic correlation was found in
patients with PNES, in comparison to healthy participants, between the right
inferior parietal/central region and the bilateral cerebellum, and between the
bilateral anterior cingulate cortex and the left parahippocampal gyrus.
CONCLUSIONS: To the best of our knowledge, this is the first study describing
FDG-PET alterations in patients with PNES. Although we cannot exclude that our
data reflect changes due to comorbidities, they may indicate a dysfunction of
neural systems in patients with PNES. Hypometabolism regions might relate to two
of the pathophysiological mechanisms that may be involved in PNES, that is,
emotional dysregulation (anterior cingulate hypometabolism) and dysfunctional
processes underlying the consciousness of the self and the environment (right
parietal hypometabolism).
TRIAL REGISTRATION NUMBER: NCT00484523.

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DOI: 10.1136/jnnp-2014-309390
PMID: 25466258 [Indexed for MEDLINE]

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