Table 1

Summary of SPECT, PET and fMRI studies of motor and sensory hysteria

Study, participants	Impairment	Method	Critical comparison	Changes during task
Tiihonen 19958—Single case	L paralysis, paresthesia	SPECT	Affected vs recovered during stimulation of L median nerve	⇑Right frontal ⇓Right parietal
Marshall 199712—Single case	L paralysis	PET	Motor execution attempt vs motor preparation	⇑Right ACC and right OFC ○Motor cortex
Spence 200013—Three patients, four feigners, two controls	Hysterical weakness	PET	Patients vs feigners	Patients: ⇓Left DLPFC Feigners: ⇓Right DLPFC
Vuilleumier 20019—Seven patients	Subjective paralysis, weakness, some with sensory loss	SPECT	Affected versus recovered and resting state vs vibratory stimulus.	⇓Contralateral basal ganglia and thalamus in affected state ⇑Ipsilateral pre and post central gyrus on recovery
Mailis-Gagnon 200314—Four patients	Chronic pain with hysterical anaesthesia	fMRI	Affected vs unaffected body parts and mild vs noxious stimulation.	⇑ACC ○Thalamus, insula, inferior frontal, posterior ACC ⇓Contralateral motor cortices, bilateral prefrontal
Werring 200415—Five patients	Medically unexplained vision loss	fMRI	8 Hz visual stimulation vs darkness	⇑Left posterior ACC, left inferior frontal cortex, left insula-claustrum, bilateral striatum and thalami, left limbic structures ⇓Visual cortex
Burgmer et al 200616—Four patients	Left or right sided hand paralysis	fMRI	Passive observation of video clip of moving hand or hand at rest.	⇓Cortical hand areas during movement observation
Ghaffar 200617—Three patients	Unilateral conversion disorder, sensory subtype	fMRI	Vibratory stimulation of affected area vs unaffected area vs bilateral stimulation	⇑OFC, ACC, secondary somatosensory cortex, basal ganglia/putamen, thalamus ○Contralateral primary somatosensory cortex
Stone 200718—Four patients, four feigners	Unilateral ankle weakness	fMRI	Movement in feigners vs controls	⇑Putamen and lingual gyri bilaterally, left inferior frontal gyrus, left insula ⇓Right middle frontal and OFCs
de Lange 200719—Eight patients	Arm paralysis	fMRI	Mental rotation of affected vs unaffected arm	⇑Medial prefrontal cortex, superior temporal cortex No change in motor activation
Kanaan et al 20075 Single case	R sided paralysis	fMRI	Recalling traumatic vs non-traumatic memories	⇑Amygdala and right inferior frontal lobe ⇓Motor cortex
Cojan 200920—Single case, 30 healthy controls with feigning condition	L arm weakness	fMRI	GO–NOGO task: affected left vs right hand; preparation versus response vs response inhibition; patient vs controls.	Left hand preparation:⇑right motor cortex, left OFC, right vmPFC and PCC; left hand response failure: ⇑right ventrolateral PFC, left SFG and bilateral precuneus
de Lange 201021—Eight patients	Full or partial right or left arm paralysis	fMRI	Mental rotation of affected vs unaffected arm	Connectivity analysis: increased positive coupling between DLPFC and dorsal premotor cortex. Increased negative coupling between DLPFC and dorsal premotor cortex.
Voon 2010a22—Eight patients	Psychogenic tremor	fMRI	Conversion vs voluntary tremor	⇑Cerebellar vermis, left sensorimotor cortex. ⇓Right temporoparietal junction Decrease functional connectivity between right temporoparietal junction and: bilateral sensorimotor cortices, bilateral cerebellar vermis, left ventral striatum, and bilateral ventral cingulate/medial PFC
Voon 2010b6—16 patients, 16 matched controls	Psychogenic tremor, dystonia or gait abnormalities	fMRI	Functional connectivity in patients versus controls during affective stimulation	○Right amygdala to fearful versus neutral compared with happy vs neutral faces. ⇑Right amygdala happy faces Greater functional connectivity between the right amygdala and the right supplementary motor

⇑, increased activation; ⇓, decreased activation; ○, lack of expected activation.
ACC, anterior cingulate cortex; DLPFC, dorsolateral prefrontal cortex; fMRI, functional MRI; OFC, orbitofrontal cortex; PCC, posterior cingulate cortex; PET, positron emission tomography; PFC, prefrontal cortex; SFG, superior frontal gyrus; SPECT, single photon emission computed tomography; vmPFC, ventromedial prefrontal cortex.