Abstract:

Objective: To explore changes of brain structure in patients with functional movement disorder (FMD) and their correlation with disease severity. Methods: Nine patients with FMD (FMD group) as well as 10 gender-and age-matched healthy volunteers (control group) were recruited in Ruijin Hospital, Shanghai Jiaotong University School of Medicine, from May to October 2023, and then they underwent MRI. Simplified Functional Movement Disorder Rating Scale (S-FMDRS) was used to assess movement disorder symptoms and severity. Clinical Global Impression-Severity (CGI-S) was used to evaluate disease severity. Somatoform Dissociation Questionnaire-20 (SDQ-20) was used to assess body dissociation. Chinese version of Maltreatment and Abuse Chronology of Exposure (MACE) was used to assess childhood abuse situation. 36-Item Short Form of Health Survey (SF-36) was used to assess health status. Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale 17 (HAMD-17) were used to evaluate anxiety and depression. Results: Compared with the control group, the FMD group exhibited higher scores on SDQ-20 (Z=2.259, P=0.028) and Chinese version of MACE (t=-3.570, P=0.002) as well as HAMA (t=-3.999, P=0.001), while SF-36 scores for vitality (t=3.091, P=0.009) and social functioning (t=2.275, P=0.046) were lower in the FMD group. Cortical thickness was greater in the FMD group in the right inferior occipital gyrus and sulcus cortex (t=-2.924, P=0.009), right anterior cingulate gyrus and sulcus cortex (t=-3.286, P=0.004), right orbitofrontal cortex (t=-2.381, P=0.029), while thickness in the left subcallosal area (t=2.492, P=0.023) and left paracentral lobule gyrus and sulcus (t=2.139, P=0.047), as well as volume of the right cerebellar white matter (t=2.685, P=0.016), left cerebellar white matter (t=2.121, P=0.049), and the middle posterior region of the corpus callosum (t=2.550, P=0.021) were smaller than those of the control group. Correlation analysis revealed left cerebellar white matter were positively correlated with disease duration (r=0.837, P=0.038), while cortical thickness in the left subcallosal area were negatively correlated with disease duration (r=-0.831, P=0.040). Conclusions: There are structural changes in the limbic system, sensorimotor area, visual cortex, and certain white matter regions in the brains of FMD patients, and several regions were correlated with the disease duration.

Key words: Conversion disorder, Motor disorders, Magnetic resonance imaging, Neuropsychological tests

摘要：

目的: 探讨功能性运动障碍患者脑结构改变及其与疾病严重程度的相关性。方法: 纳入2023年5-10月上海交通大学医学院附属瑞金医院诊断与治疗的9例功能性运动障碍患者以及性别和年龄相匹配的10例健康志愿者，均行头部MRI检查，采用简化版功能性运动障碍评价量表（S-FMDRS）评价运动障碍症状及其严重程度，临床总体印象量表-疾病严重程度（CGI-S）评价疾病严重程度，躯体分离量表20项（SDQ-20）评价躯体形式障碍，虐待年报量表（MACE）中文版评价儿童期受虐待情况，健康调查简表36项（SF-36）评价健康状况，汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表17项（HAMD-17）评价焦虑和抑郁情绪。结果: 功能性运动障碍患者SDQ-20评分（Z=2.259，P=0.028）、MACE中文版评分（t=-3.570，P=0.002）和HAMA评分（t=-3.999，P=0.001）高于对照者，SF-36量表之活力（t=3.091，P=0.009）及社会功能（t=2.275，P=0.046）分评分低于对照者。功能性运动障碍患者右侧枕下沟回皮质（t=-2.924，P=0.009）、右侧前扣带沟回皮质（t=-3.286，P=0.004）、右侧眶额皮质（t=-2.381，P=0.029）厚度大于对照者，左侧胼胝体下区皮质（t=2.492，P=0.023）、左侧中央旁小叶沟回皮质（t=2.139，P=0.047）厚度以及右侧小脑白质（t=2.685，P=0.016）、左侧小脑白质（t=2.121，P=0.049）、胼胝体中后区（t=2.550，P=0.021）体积小于对照者。相关分析显示，左侧小脑白质体积与病程呈正相关（r=0.837，P=0.038），而左侧胼胝体下区皮质厚度与病程呈负相关（r=-0.831，P=0.040）。结论: 功能性运动障碍患者边缘系统、感觉运动区、视觉皮质和部分脑白质存在结构改变，部分脑区与病程具有相关性。

关键词: 转换障碍, 运动障碍, 磁共振成像, 神经心理学测验