Altered self-processing brain networks in paediatric functional neurological disorder
Ishan C. Walpola, Adith Mohan, Sheryl Foster, Kasia Kozlowska
Abstract
OBJECTIVES: Functional neurological disorder (FND) is associated with altered self-processing - the neural processes that underpin the individual's self-agency and sense of self. This study used resting-state functional magnetic resonance imaging to examine three nested meta-analytically defined self-processing brain networks in 28 children with mixed FND symptoms and 31 healthy controls. METHODS: Regions of interest (ROIs) for each layer of brain network analysis were defined using the nested hierarchical model of self-processing developed by Northoff and colleagues specifying the insula (interoceptive processing), temporoparietal junction [TPJ] (exteroceptive processing), and anterior medial prefrontal cortex [amPFC] (mental-self processing) as seed ROIs. Connectivity differences for each layer of self-processing were examined with ROI-to-ROI analysis. Correlation analyses were conducted in relation to adverse childhood experiences (ACEs) and arousal (resting heart rate). RESULTS: At the mental-self layer, children with FND (vs. controls) had increased functional connectivity between the amPFC and thalamus and left dorsolateral prefrontal cortex (dlPFC). Children with functional seizures (vs. other FND symptoms) had decreased functional connectivity between the amPFC and right TPJ. At the interoceptive layer, the FND group showed a positive correlation between ACEs and functional connectivity between the left insula seed and right TPJ and dorsal anterior cingulate cortex (dACC). There were no findings at the exteroceptive layer of self-processing. CONCLUSIONS: Our findings suggest that ACEs (including trauma) are associated with altered self-processing in brain networks in children with FND. Further examination of self-processing is likely to prove a fruitful endeavour both in therapy and in future FND research.