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Anterior hippocampal grey matter predicts mental health outcome in functional neurological disorders: an exploratory pilot study
  1. David L Perez1,2,3,
  2. Benjamin Williams1,
  3. Nassim Matin1,
  4. Julie Mello4,
  5. Bradford C Dickerson3,5,
  6. W Curt LaFrance Jr6,7,
  7. Matcheri S Keshavan8
  1. 1Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
  4. 4Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
  6. 6Neuropsychiatry and Behavioral Neurology Division, Rhode Island Hospital, Providence, Rhode Island, USA
  7. 7Departments of Psychiatry and Neurology, Brown University, Alpert Medical School, Providence, Rhode Island, USA
  8. 8Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr David L Perez, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA 02129, USA; dlperez{at}partners.org

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Introduction

Advancements in the management of FND emphasise a ‘rule-in’ diagnosis and roles for cognitive behavioural therapy (CBT)1 and physical therapy (PT).2 Neuroimaging studies have also started delineating the neuropathophysiology of FND.3 In the same cohort as this present study, we previously identified that impaired mental health and increased trait anxiety correlated with individual differences in amygdalar volume in patients with FND, while diminished physical functioning was associated with reduced anterior insular volume.4 In FND, the magnitude of adverse life event burden also correlated with decreased insular and hippocampal volumes.5

This pilot voxel-based morphometry (VBM) study used a within-group design to investigate the relationship between baseline volumetric profiles and prospectively collected 6-month outcome data in 22 patients with FND. Stratified comparative analyses with 27 controls were performed to contextualise statistically significant within-group findings. Based on the outcome literature6 and previously described corticolimbic associations with health status and adverse life events,4 5 we hypothesised that baseline amygdalar–hippocampal and cingulo-insular volumes would predict clinical outcomes in FND.

Methods

Methods were adapted from Perez et al.4

Participants

Twenty-two subjects with FND (19 women, 3 men; age=41.7±11.0 years; illness duration=3.9±4.6 years) were recruited from the Massachusetts General Hospital (MGH) FND Clinic with baseline (MRI+psychometric data) and follow-up (psychometric only) data collected at 6.4±1.1 months; 4 of 26 initial patients were lost to follow-up. Twenty-seven healthy controls (22 women, 5 men; age=40.5±10.8 years) were also recruited through local advertisements.

Patients met criteria for clinically established functional movement disorders (n=12), documented (n=8) or clinically established (n=1) psychogenic non-epileptic seizures and/or exhibited signs of functional weakness (n=9). Eight had mixed symptoms. Inclusion/exclusion criteria were as previously described.4 Psychiatric comorbidities were assessed through the Structured Clinical Interview for DSM-IV-TR. Nineteen patients were on psychotropic medications at …

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