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      Functional neuroimaging of conversion disorder: The role of ancillary activation

      research-article
      Author(s): , MD a , * , , MD, MSc b , c , * , , PhD d , * , , MD, PhD b , e , * , , MD, MPhil, PhD b , c
      Publication date (Electronic):
      Journal: NeuroImage : Clinical
      Publisher: Elsevier
      Keywords: Conversion disorder, Functional neuroimaging, Sensory

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          Abstract

          Background

          Previous functional neuroimaging studies investigating the neuroanatomy of conversion disorder have yielded inconsistent results that may be attributed to small sample sizes and disparate methodologies. The objective of this study was to better define the functional neuroanatomical correlates of conversion disorder.

          Methods

          Ten subjects meeting clinical criteria for unilateral sensory conversion disorder underwent fMRI during which a vibrotactile stimulus was applied to anesthetic and sensate areas. A block design was used with 4 s of stimulation followed by 26 s of rest, the pattern repeated 10 times. Event-related group averages of the BOLD response were compared between conditions.

          Results

          All subjects were right-handed females, with a mean age of 41. Group analyses revealed 10 areas that had significantly greater activation ( p < .05) when stimulation was applied to the anesthetic body part compared to the contralateral sensate mirror region. They included right paralimbic cortices (anterior cingulate cortex and insula), right temporoparietal junction (angular gyrus and inferior parietal lobule), bilateral dorsolateral prefrontal cortex (middle frontal gyri), right orbital frontal cortex (superior frontal gyrus), right caudate, right ventral-anterior thalamus and left angular gyrus. There was a trend for activation of the somatosensory cortex contralateral to the anesthetic region to be decreased relative to the sensate side.

          Conclusions

          Sensory conversion symptoms are associated with a pattern of abnormal cerebral activation comprising neural networks implicated in emotional processing and sensory integration. Further study of the roles and potential interplay of these networks may provide a basis for an underlying psychobiological mechanism of conversion disorder.

          Highlights

          • •

            fMRI was used to study subjects with unilateral sensory conversion disorder.

          • •

            Sensory stimulation of anesthetic body part compared to sensate mirror region

          • •

            10 brain regions, including right limbic cortices and TPJ, were abnormally active.

          • •

            Implicated neural networks may provide a mechanism for conversion disorder.

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          Most cited references32

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          A multimodal cortical network for the detection of changes in the sensory environment.

          J Downar, A P Crawley, D. Mikulis … (2000)
          Sensory stimuli undergoing sudden changes draw attention and preferentially enter our awareness. We used event-related functional magnetic-resonance imaging (fMRI) to identify brain regions responsive to changes in visual, auditory and tactile stimuli. Unimodally responsive areas included visual, auditory and somatosensory association cortex. Multimodally responsive areas comprised a right-lateralized network including the temporoparietal junction, inferior frontal gyrus, insula and left cingulate and supplementary motor areas. These results reveal a distributed, multimodal network for involuntary attention to events in the sensory environment. This network contains areas thought to underlie the P300 event-related potential and closely corresponds to the set of cortical regions damaged in patients with hemineglect syndromes.
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            Modulating the experience of agency: a positron emission tomography study.

            C. Farrer, N Franck, N Georgieff … (2003)
            This study investigated agency, the feeling of being causally involved in an action. This is the feeling that leads us to attribute an action to ourselves rather than to another person. We were interested in the effects of experimentally modulating this experience on brain areas known to be involved in action recognition and self-recognition. We used a device that allowed us to modify the subject's degree of control of the movements of a virtual hand presented on a screen. Four main conditions were used: (1) a condition where the subject had a full control of the movements of the virtual hand, (2) a condition where the movements of the virtual hand appeared rotated by 25 degrees with respect to the movements made by the subject, (3) a condition where the movements of the virtual hand appeared rotated by 50 degrees, and (4) a condition where the movements of the virtual hand were produced by another person and did not correspond to the subject's movements. The activity of two main brain areas appeared to be modulated by the degree of discrepancy between the movement executed and the movement seen on the screen. In the inferior part of the parietal lobe, specifically on the right side, the less the subject felt in control of the movements of the virtual hand, the higher the level of activation. A reverse covariation was observed in the insula. These results demonstrate that the level of activity of specific brain areas maps onto the experience of causing or controlling an action. The implication of these results for understanding pathological conditions is discussed.
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              Activity in right temporo-parietal junction is not selective for theory-of-mind.

              J. P. Mitchell (2008)
              Recent researchers have suggested that a region of right temporo-parietal junction (RTPJ) selectively subserves the attribution of beliefs to other people (Saxe R, Kanwisher N. 2003. People thinking about thinking people: fMRI investigations of theory of mind. NeuroImage. 19:1835-1842; Saxe R, Powell LJ. 2006. It's the thought that counts: specific brain regions for one component of theory of mind. Psychol Sci. 17:692-699; Saxe R, Wexler A. 2005. Making sense of another mind: the role of the right temporo-parietal junction. Neuropsychologia. 43:1391-1399). At the same time, a similar RTPJ region has been observed repeatedly in a variety of nonsocial tasks that require participants to redirect attention to task-relevant stimuli (e.g., Corbetta M, Shulman GL. 2002. Control of goal-directed and stimulus-driven attention in the brain. Nat Rev Neurosci. 3:201-215; Serences JT, Shomstein S, Leber AB, Golay X, Egeth HE, Yantis S. 2005. Coordination of voluntary and stimulus-driven attentional control in human cortex. Psychol Sci. 16:114-122). However, because these 2 sets of tasks have never been compared within the same participants, it remains unclear whether these observations refer to the exact same region of RTPJ or may instead involve neighboring regions with distinct functional profiles. To test the claim that there is a region of RTPJ selective for belief attribution, the current study used functional neuroimaging to examine the extent to which cortical loci identified by a "theory-of-mind localizer" also distinguish between trials on a target detection task that varied demands to reorient attention (i.e., a version of the "Posner cueing task"). Results were incompatible with claims of RTPJ selectivity for mental state attribution. Regardless of whether regions were defined from group analyses or were individually tailored for each participant, RTPJ activity was also modulated by the nonsocial attentional task. The overlap between theory-of-mind and attentional reorienting suggests the need for new accounts of RTPJ function that integrate across these disparate task comparisons.
              Article 0 comments Cited 105 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Matthew J. Burke
                Omar Ghaffar
                W. Richard Staines
                Jonathan Downar
                Anthony Feinstein
                Journal
                Journal ID (nlm-ta): Neuroimage Clin
                Journal ID (iso-abbrev): Neuroimage Clin
                Title: NeuroImage : Clinical
                Publisher: Elsevier
                ISSN (Electronic): 2213-1582
                Publication date PMC-release: 30 September 2014
                Publication date (Electronic): 30 September 2014
                Publication date Collection: 2014
                Volume: 6
                Pages: 333-339
                Affiliations
                [a ]Department of Neurology, University of Toronto, Toronto, Ontario M4N 3M5, Canada
                [b ]Department of Psychiatry, University of Toronto, Toronto, Ontario M4N 3M5, Canada
                [c ]Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG16, Toronto, Ontario M4N 3M5, Canada
                [d ]Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
                [e ]Toronto Western Hospital, 399 Bathurst Street, Room 7M-415, Toronto, Ontario M5T 2S8, Canada
                Author notes
                [* ]Correspondence to: Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Room FG16, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. Tel: + 1 416 480 4216; fax: + 1 416 480 4613. matt.burke@ 123456mail.utoronto.ca omar.ghaffar@ 123456utoronto.ca rstaines@ 123456uwaterloo.ca Jonathan.Downar@ 123456uhn.ca
                Article
                Publisher ID: S2213-1582(14)00152-1
                DOI: 10.1016/j.nicl.2014.09.016
                PMC ID: 4215400
                PubMed ID: 25379447
                SO-VID: 0d610853-b220-4527-b060-cf4f037ef915
                Copyright © © 2014 The Authors. Published by Elsevier Inc. All rights reserved.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

                History
                Date received : 9 July 2014
                Date revision received : 24 September 2014
                Date accepted : 26 September 2014
                Categories
                Subject: Article

                Keywords: conversion disorder,functional neuroimaging,sensory
                Data availability:
                Keywords: conversion disorder, functional neuroimaging, sensory

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