Skip to main content
Log in

Altered Functional Connectivity Patterns of the Insular Subregions in Psychogenic Nonepileptic Seizures

  • Original Paper
  • Published:
Brain Topography Aims and scope Submit manuscript

Abstract

Neuroimaging studies have demonstrated that psychogenic nonepileptic seizures (PNES) are characterized by unstable cognitive-emotional and motor system, which is engaged in hyperactivity of limbic regions and sensorimotor area. The insula, which is a part of the limbic system, includes various subregions with some distinct connectivity patterns separately. However, whether these insular subregions show different connectivity patterns respectively in PNES remains largely unknown. We aimed to investigate the functional connectivity (FC) of insular subregions in PNES and extend the understanding of the complex pathophysiological mechanisms of this disease. A resting-state FC based on the insular subregions were conducted in 18 patients and 20 healthy controls. We examined the differences in FC values between PNES patients and controls using two sample t test. Our results showed patients had significantly stronger FC between insular subregions and sensorimotor network, lingual gyrus, superior parietal gyrus and putamen, which suggested a hyperlink pattern of insular subregions involved in abnormal emotion regulation, cognitive processes and motor function in PNES. Pearson correlation analysis between the mean FC values within abnormal regions and the frequency of PNES further indicated PNES exhibited abnormal functional organization whose stressful emotion of patients have great direct influence on their motor functions. The differentially impaired functional connectivity patterns of insular subregions might provide new insights into the complex neurological mechanism of PNES.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Alexander GE, Crutcher MD (1990) Preparation for movement: neural representations of intended direction in three motor areas of the monkey. J Neurophysiol 64(1):133–150

    CAS  PubMed  Google Scholar 

  • Bakvis P, Spinhoven P, Zitman FG, Roelofs K (2011) Automatic avoidance tendencies in patients with psychogenic non-epileptic seizures. Seizure 20(8):628–634. doi:10.1016/j.seizure.2011.06.006

    Article  PubMed  Google Scholar 

  • Baslet G (2011) Psychogenic non-epileptic seizures: a model of their pathogenic mechanism. Seizure 20(1):1–13. doi:10.1016/j.seizure.2010.10.032

    Article  PubMed  Google Scholar 

  • Baslet G (2012) Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium? Neuropsychiatr Dis Treat 8:585–598. doi:10.2147/NDT.S32301

    Article  PubMed Central  PubMed  Google Scholar 

  • Benbadis SR, Siegrist K, Tatum WO, Heriaud L, Anthony K (2004) Short-term outpatient EEG video with induction in the diagnosis of psychogenic seizures. Neurology 63(9):1728–1730

    Article  CAS  PubMed  Google Scholar 

  • Bettus G, Guedj E, Joyeux F, Confort-Gouny S, Soulier E, Laguitton V, Cozzone PJ, Chauvel P, Ranjeva JP, Bartolomei F, Guye M (2009) Decreased basal fMRI functional connectivity in epileptogenic networks and contralateral compensatory mechanisms. Hum Brain Mapp 30(5):1580–1591. doi:10.1002/hbm.20625

    Article  PubMed  Google Scholar 

  • Biswal B, Yetkin FZ, Haughton VM, Hyde JS (1995) Functional connectivity in the motor cortex of resting human brain using echo-planar MRI. Magn Reson Med 34(4):537–541

    Article  CAS  PubMed  Google Scholar 

  • Burgmer M, Konrad C, Jansen A, Kugel H, Sommer J, Heindel W, Ringelstein EB, Heuft G, Knecht S (2006) Abnormal brain activation during movement observation in patients with conversion paralysis. Neuroimage 29(4):1336–1343. doi:10.1016/j.neuroimage.2005.08.033

    Article  PubMed  Google Scholar 

  • Cauda F, D’Agata F, Sacco K, Duca S, Geminiani G, Vercelli A (2011) Functional connectivity of the insula in the resting brain. Neuroimage 55(1):8–23. doi:10.1016/j.neuroimage.2010.11.049

    Article  PubMed  Google Scholar 

  • Cerliani L, Thomas RM, Jbabdi S, Siero JC, Nanetti L, Crippa A, Gazzola V, D’Arceuil H, Keysers C (2012) Probabilistic tractography recovers a rostrocaudal trajectory of connectivity variability in the human insular cortex. Hum Brain Mapp 33(9):2005–2034. doi:10.1002/hbm.21338

    Article  PubMed Central  PubMed  Google Scholar 

  • Cloutman LL, Binney RJ, Drakesmith M, Parker GJ, Lambon Ralph MA (2012) The variation of function across the human insula mirrors its patterns of structural connectivity: evidence from in vivo probabilistic tractography. Neuroimage 59(4):3514–3521. doi:10.1016/j.neuroimage.2011.11.016

    Article  PubMed  Google Scholar 

  • Craig AD (2009) How do you feel—now? The anterior insula and human awareness. Nat Rev Neurosci 10(1):59–70. doi:10.1038/nrn2555

    Article  CAS  PubMed  Google Scholar 

  • de Lange FP, Roelofs K, Toni I (2007) Increased self-monitoring during imagined movements in conversion paralysis. Neuropsychologia 45(9):2051–2058. doi:10.1016/j.neuropsychologia.2007.02.002

    Article  PubMed  Google Scholar 

  • Deen B, Pitskel NB, Pelphrey KA (2011) Three systems of insular functional connectivity identified with cluster analysis. Cereb Cortex 21(7):1498–1506. doi:10.1093/cercor/bhq186

    Article  PubMed Central  PubMed  Google Scholar 

  • Devinsky O, Gazzola D, LaFrance WC Jr (2011) Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol 7(4):210–220. doi:10.1038/nrneurol.2011.24

    Article  PubMed  Google Scholar 

  • Ding JR, An D, Liao W, Li J, Wu GR, Xu Q, Long Z, Gong Q, Zhou D, Sporns O, Chen H (2013) Altered functional and structural connectivity networks in psychogenic non-epileptic seizures. PLoS One 8(5):e63850. doi:10.1371/journal.pone.0063850

    Article  PubMed Central  PubMed  Google Scholar 

  • Dosenbach NU, Fair DA, Miezin FM, Cohen AL, Wenger KK, Dosenbach RA, Fox MD, Snyder AZ, Vincent JL, Raichle ME, Schlaggar BL, Petersen SE (2007) Distinct brain networks for adaptive and stable task control in humans. Proc Natl Acad Sci USA 104(26):11073–11078. doi:10.1073/pnas.0704320104

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Dupont S, Bouilleret V, Hasboun D, Semah F, Baulac M (2003) Functional anatomy of the insula: new insights from imaging. Surg Radiol Anat 25(2):113–119. doi:10.1007/s00276-003-0103-4

    Article  CAS  PubMed  Google Scholar 

  • Fair DA, Cohen AL, Dosenbach NU, Church JA, Miezin FM, Barch DM, Raichle ME, Petersen SE, Schlaggar BL (2008) The maturing architecture of the brain’s default network. Proc Natl Acad Sci USA 105(10):4028–4032. doi:10.1073/pnas.0800376105

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Fogassi L, Ferrari PF, Gesierich B, Rozzi S, Chersi F, Rizzolatti G (2005) Parietal lobe: from action organization to intention understanding. Science 308(5722):662–667. doi:10.1126/science.1106138

    Article  CAS  PubMed  Google Scholar 

  • Fox MD, Zhang D, Snyder AZ, Raichle ME (2009) The global signal and observed anticorrelated resting state brain networks. J Neurophysiol 101(6):3270–3283. doi:10.1152/jn.90777.2008

    Article  PubMed Central  PubMed  Google Scholar 

  • Greicius MD, Supekar K, Menon V, Dougherty RF (2009) Resting-state functional connectivity reflects structural connectivity in the default mode network. Cereb Cortex 19(1):72–78. doi:10.1093/cercor/bhn059

    Article  PubMed Central  PubMed  Google Scholar 

  • Griffiths PD, Perry RH, Crossman AR (1994) A detailed anatomical analysis of neurotransmitter receptors in the putamen and caudate in Parkinson’s disease and Alzheimer’s disease. Neurosci Lett 169(1–2):68–72

    Article  CAS  PubMed  Google Scholar 

  • Guo WB, Liu F, Xue ZM, Yu Y, Ma CQ, Tan CL, Sun XL, Chen JD, Liu ZN, Xiao CQ, Chen HF, Zhao JP (2011) Abnormal neural activities in first-episode, treatment-naive, short-illness-duration, and treatment-response patients with major depressive disorder: a resting-state fMRI study. J Affect Disord 135(1–3):326–331. doi:10.1016/j.jad.2011.06.048

    Article  PubMed  Google Scholar 

  • Guo W, Liu F, Liu J, Yu L, Zhang J, Zhang Z, Xiao C, Zhai J, Zhao J (2014) Abnormal causal connectivity by structural deficits in first-episode, drug-naive schizophrenia at rest. Schizophr Bull. doi:10.1093/schbul/sbu126

  • Guz H, Doganay Z, Ozkan A, Colak E, Tomac A, Sarisoy G (2004) Conversion and somatization disorders: dissociative symptoms and other characteristics. J Psychosom Res 56(3):287–291. doi:10.1016/S0022-3999(03)00069-2

    Article  PubMed  Google Scholar 

  • Hoptman MJ, Zuo XN, D’Angelo D, Mauro CJ, Butler PD, Milham MP, Javitt DC (2012) Decreased interhemispheric coordination in schizophrenia: a resting state fMRI study. Schizophr Res 141(1):1–7. doi:10.1016/j.schres.2012.07.027

    Article  PubMed Central  PubMed  Google Scholar 

  • Kapur N, Friston KJ, Young A, Frith CD, Frackowiak RS (1995) Activation of human hippocampal formation during memory for faces: a PET study. Cortex 31(1):99–108

    Article  CAS  PubMed  Google Scholar 

  • Krumholz A, Niedermeyer E (1983) Psychogenic seizures: a clinical study with follow-up data. Neurology 33(4):498–502

    Article  CAS  PubMed  Google Scholar 

  • Kurth F, Eickhoff SB, Schleicher A, Hoemke L, Zilles K, Amunts K (2010a) Cytoarchitecture and probabilistic maps of the human posterior insular cortex. Cereb Cortex 20(6):1448–1461. doi:10.1093/cercor/bhp208

    Article  PubMed Central  PubMed  Google Scholar 

  • Kurth F, Zilles K, Fox PT, Laird AR, Eickhoff SB (2010b) A link between the systems: functional differentiation and integration within the human insula revealed by meta-analysis. Brain Struct Funct 214(5–6):519–534. doi:10.1007/s00429-010-0255-z

    Article  PubMed  Google Scholar 

  • Landgrebe M, Barta W, Rosengarth K, Frick U, Hauser S, Langguth B, Rutschmann R, Greenlee MW, Hajak G, Eichhammer P (2008) Neuronal correlates of symptom formation in functional somatic syndromes: a fMRI study. Neuroimage 41(4):1336–1344. doi:10.1016/j.neuroimage.2008.04.171

    Article  PubMed  Google Scholar 

  • Lesser RP (2003) Treatment and outcome of psychogenic nonepileptic seizures. Epilepsy Curr 3(6):198–200. doi:10.1046/j.1535-7597.2003.03601.x

    Article  PubMed Central  PubMed  Google Scholar 

  • Liao W, Zhang Z, Pan Z, Mantini D, Ding J, Duan X, Luo C, Wang Z, Tan Q, Lu G, Chen H (2011) Default mode network abnormalities in mesial temporal lobe epilepsy: a study combining fMRI and DTI. Hum Brain Mapp 32(6):883–895. doi:10.1002/hbm.21076

    Article  PubMed  Google Scholar 

  • Liu F, Guo W, Fouche JP, Wang Y, Wang W, Ding J, Zeng L, Qiu C, Gong Q, Zhang W, Chen H (2013a) Multivariate classification of social anxiety disorder using whole brain functional connectivity. Brain Struct Funct. doi:10.1007/s00429-013-0641-4

    Google Scholar 

  • Liu F, Guo W, Liu L, Long Z, Ma C, Xue Z, Wang Y, Li J, Hu M, Zhang J, Du H, Zeng L, Liu Z, Wooderson SC, Tan C, Zhao J, Chen H (2013b) Abnormal amplitude low-frequency oscillations in medication-naive, first-episode patients with major depressive disorder: a resting-state fMRI study. J Affect Disord 146(3):401–406. doi:10.1016/j.jad.2012.10.001

    Article  PubMed  Google Scholar 

  • Liu F, Hu M, Wang S, Guo W, Zhao J, Li J, Xun G, Long Z, Zhang J, Wang Y, Zeng L, Gao Q, Wooderson SC, Chen J, Chen H (2012) Abnormal regional spontaneous neural activity in first-episode, treatment-naive patients with late-life depression: a resting-state fMRI study. Prog Neuropsychopharmacol Biol Psychiatry 39(2):326–331

  • Liu F, Xie B, Wang Y, Guo W, Fouche JP, Long Z, Wang W, Chen H, Li M, Duan X, Zhang J, Qiu M (2014) Characterization of post-traumatic stress disorder using resting-state fMRI with a multi-level parametric classification approach. Brain Topogr. doi:10.1007/s10548-014-0386-2

    Google Scholar 

  • Long Z, Duan X, Wang Y, Liu F, Zeng L, Zhao JP, Chen H (2014) Disrupted structural connectivity network in treatment-naive depression. Prog Neuropsychopharmacol Biol Psychiatry 56C, 18–26. doi:10.1016/j.pnpbp.2014.07.007

  • Magaudda A, Gugliotta SC, Tallarico R, Buccheri T, Alfa R, Lagana A (2011) Identification of three distinct groups of patients with both epilepsy and psychogenic nonepileptic seizures. Epilepsy Behav 22(2):318–323. doi:10.1016/j.yebeh.2011.07.005

    Article  CAS  PubMed  Google Scholar 

  • Montoya A, Price BH, Lepage M (2006) Neural correlates of ‘functional’ symptoms in neurology. Funct Neurol 21(4):193–197

    PubMed  Google Scholar 

  • Nanetti L, Cerliani L, Gazzola V, Renken R, Keysers C (2009) Group analyses of connectivity-based cortical parcellation using repeated k-means clustering. Neuroimage 47(4):1666–1677. doi:10.1016/j.neuroimage.2009.06.014

    Article  PubMed  Google Scholar 

  • Peng ZW, Xu T, He QH, Shi CZ, Wei Z, Miao GD, Jing J, Lim KO, Zuo XN, Chan RC (2014) Default network connectivity as a vulnerability marker for obsessive compulsive disorder. Psychol Med 44(7):1475–1484. doi:10.1017/S0033291713002250

    Article  CAS  PubMed  Google Scholar 

  • Picard N, Strick PL (2003) Activation of the supplementary motor area (SMA) during performance of visually guided movements. Cereb Cortex 13(9):977–986

    Article  PubMed  Google Scholar 

  • Reuber M (2008) Psychogenic nonepileptic seizures: answers and questions. Epilepsy Behav 12(4):622–635. doi:10.1016/j.yebeh.2007.11.006

    Article  PubMed  Google Scholar 

  • Reuber M, House AO, Pukrop R, Bauer J, Elger CE (2003) Somatization, dissociation and general psychopathology in patients with psychogenic non-epileptic seizures. Epilepsy Res 57(2–3):159–167. doi:10.1016/j.eplepsyres.2003.11.004

    Article  PubMed  Google Scholar 

  • Schmahmann JD, Pandya DN, Wang R, Dai G, D’Arceuil HE, de Crespigny AJ, Wedeen VJ (2007) Association fibre pathways of the brain: parallel observations from diffusion spectrum imaging and autoradiography. Brain 130(Pt 3):630–653. doi:10.1093/brain/awl359

    Article  PubMed  Google Scholar 

  • Stone J, Zeman A, Simonotto E, Meyer M, Azuma R, Flett S, Sharpe M (2007) FMRI in patients with motor conversion symptoms and controls with simulated weakness. Psychosom Med 69(9):961–969. doi:10.1097/PSY.0b013e31815b6c14

    Article  PubMed  Google Scholar 

  • Ture U, Yasargil DC, Al-Mefty O, Yasargil MG (1999) Topographic anatomy of the insular region. J Neurosurg 90(4):720–733

    Article  CAS  PubMed  Google Scholar 

  • Uliaszek AA, Prensky E, Baslet G (2012) Emotion regulation profiles in psychogenic non-epileptic seizures. Epilepsy Behav 23(3):364–369. doi:10.1016/j.yebeh.2012.01.009

    Article  PubMed  Google Scholar 

  • van der Kruijs SJ, Bodde NM, Vaessen MJ, Lazeron RH, Vonck K, Boon P, Hofman PA, Backes WH, Aldenkamp AP, Jansen JF (2012) Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. J Neurol Neurosurg Psychiatr 83(3):239–247. doi:10.1136/jnnp-2011-300776

    Article  PubMed  Google Scholar 

  • van der Kruijs SJ, Jagannathan SR, Bodde NM, Besseling RM, Lazeron RH, Vonck KE, Boon PA, Cluitmans PJ, Hofman PA, Backes WH, Aldenkamp AP, Jansen JF (2014) Resting-state networks and dissociation in psychogenic non-epileptic seizures. J Psychiatr Res 54:126–133. doi:10.1016/j.jpsychires.2014.03.010

    Article  PubMed  Google Scholar 

  • Voon V, Brezing C, Gallea C, Ameli R, Roelofs K, LaFrance WC Jr, Hallett M (2010a) Emotional stimuli and motor conversion disorder. Brain 133(Pt 5):1526–1536. doi:10.1093/brain/awq054

    Article  PubMed Central  PubMed  Google Scholar 

  • Voon V, Gallea C, Hattori N, Bruno M, Ekanayake V, Hallett M (2010b) The involuntary nature of conversion disorder. Neurology 74(3):223–228. doi:10.1212/WNL.0b013e3181ca00e9

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Vuilleumier P, Chicherio C, Assal F, Schwartz S, Slosman D, Landis T (2001) Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain 124(Pt 6):1077–1090

    Article  CAS  PubMed  Google Scholar 

  • Waites AB, Briellmann RS, Saling MM, Abbott DF, Jackson GD (2006) Functional connectivity networks are disrupted in left temporal lobe epilepsy. Ann Neurol 59(2):335–343. doi:10.1002/ana.20733

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by 973 Project 2012CB517901, and by the Natural Science Foundation of China, Grant Nos. 61035006, 61125304, and by the Specialized Research Fund for the Doctoral Program of Higher Education of China 20120185110028. The authors have no financial relationships to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Huafu Chen.

Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, R., Liu, K., Ma, X. et al. Altered Functional Connectivity Patterns of the Insular Subregions in Psychogenic Nonepileptic Seizures. Brain Topogr 28, 636–645 (2015). https://doi.org/10.1007/s10548-014-0413-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10548-014-0413-3

Keywords

Navigation