Neuronal correlates of symptom formation in functional somatic syndromes: a fMRI study.
ABSTRACT Functional somatic syndromes are characterized by high morbidity due to various, fluctuating symptoms without objective somatic findings. There is increasing evidence for the contribution of emotional and cognitive functions to symptom formation, which has been well established in the perception of pain. In addition to their involvement in various other cognitive and emotional processes, the anterior cingulate and insular cortex are thought to contribute to the so-called "pain neuromatrix". Recent data suggest that these areas appear also to be involved in symptom manifestation in multiple chemical sensitivity. Here we used functional Magnetic Resonance Imaging (fMRI) to test whether this network is also involved in the induction of unpleasant perceptions by sham mobile phone radiation in subjectively electrosensitive patients. This design enabled us to completely dissociate the unpleasant subjective perception from any real physical stimulus. Fifteen subjectively electrosensitive patients and 15 age- and gender-matched healthy controls were exposed to sham mobile phone radiation and heat as a control condition. The perceived stimulus intensities were rated on a five-point scale. During anticipation of and exposure to sham mobile phone radiation increased activations in anterior cingulate and insular cortex as well as fusiform gyrus were seen in the electrosensitive group compared to controls, while heat stimulation led to similar activations in both groups. Symptom manifestation during sham exposure to mobile phone radiation was accompanied by specific alterations of cortical activity in anterior cingulate and insular cortex in subjectively electrosensitive patients further supporting the involvement of these areas in the perception of unpleasantness and generation of functional somatic syndromes.
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ABSTRACT: Many people with tinnitus also suffer from hyperacusis. Both clinical and basic scientific data indicate an overlap in pathophysiologic mechanisms. In order to further elucidate the interplay between tinnitus and hyperacusis we compared clinical and demographic characteristics of tinnitus patients with and without hyperacusis by analyzing a large sample from an international tinnitus patient database. The default dataset import [November 1(st), 2012] from the Tinnitus Research Initiative [TRI] Database was used for analyses. Hyperacusis was defined by the question "Do sounds cause you pain or physical discomfort?" of the Tinnitus Sample Case History Questionnaire. Patients who answered this question with "yes" were contrasted with "no"-responders with respect to 41 variables. 935 [55%] out of 1713 patients were characterized as hyperacusis patients. Hyperacusis in tinnitus was associated with younger age, higher tinnitus-related, mental and general distress; and higher rates of pain disorders and vertigo. In relation to objective audiological assessment patients with hyperacusis rated their subjective hearing function worse than those without hyperacusis. Similarly the tinnitus pitch was rated higher by hyperacusis patients in relation to the audiometrically determined tinnitus pitch. Among patients with tinnitus and hyperacusis the tinnitus was more frequently modulated by external noise and somatic maneuvers, i.e., exposure to environmental sounds and head and neck movements change the tinnitus percept. Our findings suggest that the comorbidity of hyperacusis is a useful criterion for defining a sub-type of tinnitus which is characterized by greater need of treatment. The higher sensitivity to auditory, somatosensory and vestibular input confirms the notion of an overactivation of an unspecific hypervigilance network in tinnitus patients with hyperacusis.PLoS ONE 01/2014; 9(1):e86944. · 3.73 Impact Factor
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ABSTRACT: Environmental hyperthermia is a very common risk factor for many occupations, however, its potential influences on cerebral circulation remain obscure. In this study, 20 participants underwent two simulated environmental thermal conditions (50°C/25°C, 1 hour), and their cerebral blood flows (CBFs) were quantified using a pseudo-continuous arterial spin labeling (ASL) MR imaging. During the experiment, the physiological parameters, including rectal temperature, arterial blood pressure and weight loss, heart rate and respiration rate, were recorded. And a visual analog scale (VAS) was performed during both conditions to evaluate the psychological state including vigilance, anxiety, vigor, confidence, anger, nervousness, drowsiness, loquacity. After scanning, a highly-demanding attentional task - the psychomotor vigilance test (PVT) was performed for behavioral performance evaluation. Compared with that during normothermic condition, the global CBF (gCBF) during hyperthermic condition showed tendency of decrease, but no significant differences. Regional CBFs (rCBFs) were significantly altered mainly in prefrontal cortex, somatosensory areas and limbic system. Physiological detection revealed significantly decreased diastolic pressure and systolic pressure and accelerated respiration rate. Furthermore, linear multivariate regression analysis showed that altered rCBFs in several regions could be predicted by physiological (systolic pressure, rectal temperature) and psychological (vigilance, drowsiness, nervousness, anger) changes. And PVT revealed significantly slower attentional reaction during hyperthermia, and the longer reaction time was correlated with the altered rCBF in left dorsolateral prefrontal cortex (DLPFC). These findings suggested that during short-term hyperthermia gCBF might keep relative stable under the integrated effect of physiological changes and cerebral auto-regulation, rather than decreased solely dependently on hyperthermia-induced physiological changes. Furthermore, altered regional blood distribution might be accounted for neural activity of thermal sensation and regulation, mood state and cognitive changes.Physiology & Behavior 01/2014; · 3.16 Impact Factor
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ABSTRACT: Tinnitus is a considered to be an auditory phantom phenomenon, a persistent conscious percept of a salient memory trace, externally attributed, in the absence of a sound source. It is perceived as a phenomenological unified coherent percept, binding multiple separable clinical characteristics, such as its loudness, the sidedness, the type (pure tone, noise), the associated distress and so on. A theoretical pathophysiological framework capable of explaining all these aspects in one model is highly needed. The model must incorporate both the deafferentation based neurophysiological models and the dysfunctional noise cancelling model, and propose a 'tinnitus core' subnetwork. The tinnitus core can be defined as the minimal set of brain areas that needs to be jointly activated (=subnetwork) for tinnitus to be consciously perceived, devoid of its affective components. The brain areas involved in the other separable characteristics of tinnitus can be retrieved by studies on spontaneous resting state magnetic and electrical activity in people with tinnitus, evaluated for the specific aspect investigated and controlled for other factors. By combining these functional imaging studies with neuromodulation techniques some of the correlations are turned into causal relationships. Thereof, a heuristic pathophysiological framework is constructed, integrating the tinnitus perceptual core with the other tinnitus related aspects. This phenomenological unified percept of tinnitus can be considered an emergent property of multiple, parallel, dynamically changing and partially overlapping subnetworks, each with a specific spontaneous oscillatory pattern and functional connectivity signature. Communication between these different subnetworks is proposed to occur at hubs, brain areas that are involved in multiple subnetworks simultaneously. These hubs can take part in each separable subnetwork at different frequencies. Communication between the subnetworks is proposed to occur at discrete oscillatory frequencies. As such, the brain uses multiple nonspecific networks in parallel, each with their own oscillatory signature, that adapt to the context to construct a unified percept possibly by synchronized activation integrated at hubs at discrete oscillatory frequencies.Neuroscience & Biobehavioral Reviews 04/2013; · 10.28 Impact Factor