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Physical, mental health in conversion disorder linked to brain volumes

Recent findings indicated differences in brain structures may be associated with physical and mental health in functional neurological disorder.

“The brain regions implicated in this structural neuroimaging study are areas involved in the integration of emotion processing, sensory-motor and cognitive functions, which may help us understand why patients with functional neurological disorder exhibit such a mix of symptoms,” David L. Perez, MD, MMSc, of Massachusetts General Hospital, said in a press release. “While this is a treatable condition, many patients remain symptomatic for years, and the prognosis varies from patient to patient. Advancing our understanding the pathophysiology of [functional neurological disorder (FND)] is the first step in beginning to develop better treatments.”

To assess associations between salience network regions and health status in FND, researchers conducted a voxel-based morphometry study among 26 individuals with FND and 27 healthy controls. Mental and physical health was determined by Short Form Health Survey-36 scores.

Brain volume did not differ between participants with FND and controls.

However, in stratified analyses, participants with FND with the most severe physical health impairments exhibited decreased left anterior insular volume, compared with controls.

Within-group analyses indicated an association between impaired mental health and increased trait anxiety and increased volume in the right amygdala among participants with FND.

The association between amygdalar volume and mental health, which was influenced by emotional well-being deficits and role limitations due to emotional problems, was independent of sensorimotor functional neurological symptom severity and motor FND subtype.

Secondary within-group analyses indicated increased periaqueductal grey volume was associated with role limitations due to emotional problems.

Poor physical functioning was associated with decreased volumes in the left anterior insular cortex.

“The association among FND patients between the severity of impairments in physical functioning and reduced left anterior insular volume is intriguing, given that the anterior insula has been implicated in self- and emotional awareness,” Perez said in the release. – by Amanda Oldt

Disclosures: Perez reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.