Table 1

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

Study, participantsImpairmentMethodCritical comparisonChanges during task
Tiihonen 19958—Single caseL paralysis, paresthesiaSPECTAffected vs recovered during stimulation of L median nerve
  • ⇑Right frontal

  • ⇓Right parietal

Marshall 199712—Single caseL paralysisPETMotor execution attempt vs motor preparation
  • ⇑Right ACC and right OFC

  • ○Motor cortex

Spence 200013—Three patients, four feigners, two controlsHysterical weaknessPETPatients vs feigners
  • Patients: ⇓Left DLPFC

  • Feigners: ⇓Right DLPFC

Vuilleumier 20019—Seven patientsSubjective paralysis, weakness, some with sensory lossSPECTAffected 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 patientsChronic pain with hysterical anaesthesiafMRIAffected vs unaffected body parts and mild vs noxious stimulation.
  • ⇑ACC

  • ○Thalamus, insula, inferior frontal, posterior ACC

  • ⇓Contralateral motor cortices, bilateral prefrontal

Werring 200415—Five patientsMedically unexplained vision lossfMRI8 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 patientsLeft or right sided hand paralysisfMRIPassive observation of video clip of moving hand or hand at rest.
  • ⇓Cortical hand areas during movement observation

Ghaffar 200617—Three patientsUnilateral conversion disorder, sensory subtypefMRIVibratory 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 feignersUnilateral ankle weaknessfMRIMovement in feigners vs controls
  • ⇑Putamen and lingual gyri bilaterally, left inferior frontal gyrus, left insula

  • ⇓Right middle frontal and OFCs

de Lange 200719—Eight patientsArm paralysisfMRIMental rotation of affected vs unaffected arm
  • ⇑Medial prefrontal cortex, superior temporal cortex

  • No change in motor activation

Kanaan et al 20075 Single caseR sided paralysisfMRIRecalling traumatic vs non-traumatic memories
  • ⇑Amygdala and right inferior frontal lobe

  • ⇓Motor cortex

Cojan 200920—Single case, 30 healthy controls with feigning conditionL arm weaknessfMRIGO–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 patientsFull or partial right or left arm paralysisfMRIMental 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 patientsPsychogenic tremorfMRIConversion 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 controlsPsychogenic tremor, dystonia or gait abnormalitiesfMRIFunctional 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.