Neuroplastic changes in patients with functional seizures following neurobehavioral therapy

Given the high prevalence of functional neurological symptom disorder and its negative effects on the individual, family, and society, the development of interventions to treat it—including the subtype of functional seizures (FS)—is critical. Although we have limited understanding of the neurobiolog...

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Main Authors: Ayushe A. Sharma, Jane B. Allendorfer, Stephen Correia, Tyler E. Gaston, Adam Goodman, Leslie E Grayson, Noah S. Philip, W. Curt LaFrance, Jr, Jerzy P. Szaflarski
Format: Article
Language:English
Published: Elsevier 2025-01-01
Series:NeuroImage: Clinical
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Online Access:http://www.sciencedirect.com/science/article/pii/S2213158225000440
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author Ayushe A. Sharma
Jane B. Allendorfer
Stephen Correia
Tyler E. Gaston
Adam Goodman
Leslie E Grayson
Noah S. Philip
W. Curt LaFrance, Jr
Jerzy P. Szaflarski
author_facet Ayushe A. Sharma
Jane B. Allendorfer
Stephen Correia
Tyler E. Gaston
Adam Goodman
Leslie E Grayson
Noah S. Philip
W. Curt LaFrance, Jr
Jerzy P. Szaflarski
author_sort Ayushe A. Sharma
collection DOAJ
description Given the high prevalence of functional neurological symptom disorder and its negative effects on the individual, family, and society, the development of interventions to treat it—including the subtype of functional seizures (FS)—is critical. Although we have limited understanding of the neurobiological effects of neurobehavioral therapy (NBT), studies indicate that NBT reduces seizures and improves psychological comorbidities in FS. In this study, healthy adults (N = 33) and patients with a history of TBI with (TBI-FS; N = 50) and without FS (TBI-only; N = 50) underwent magnetic resonance imaging (MRI) at 3 T approximately 12 weeks apart. TBI-FS participants underwent up to 12 sessions of NBT between scans. Structural MRI data were analyzed using voxel-based morphometry. A voxelwise repeated measures ANOVA tested changes in grey matter volume (GMV) between groups over time. Following treatment with NBT, TBI-FS participants showed a 1.23 % GMV increase in the left inferior and middle temporal gyri (pFWE < 0.05) along with a 35.78 % reduction in seizure events and decrease in depressive (p < 0.001) and anxiety (p = 0.01) symptoms. Left temporal GMV increases were directly associated (p = 0.04, r = 0.26) with improvements in overall psychological, social, and occupational functioning (p < 0.001). We observed structural brain changes within the left inferior temporal gyrus following NBT that correspond to functional and psychological improvements in patients with TBI-FS. This work highlights the need for further research into the neurobiological effects of NBT, building on the relationship between NBT and brain plasticity and demonstrating putative targets for interventions.
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spelling doaj-art-ff16da0e3db94a229c0b2b4c6baf931e2025-08-20T03:26:35ZengElsevierNeuroImage: Clinical2213-15822025-01-014610377410.1016/j.nicl.2025.103774Neuroplastic changes in patients with functional seizures following neurobehavioral therapyAyushe A. Sharma0Jane B. Allendorfer1Stephen Correia2Tyler E. Gaston3Adam Goodman4Leslie E Grayson5Noah S. Philip6W. Curt LaFrance, Jr7Jerzy P. Szaflarski8Departments of Neurology University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Corresponding authors at: UAB Epilepsy Center, University of Alabama at Birmingham, Department of Neurology, 1719 6th Avenue South, CIRC 312, Birmingham, AL 35249-0021, USA.Departments of Neurology University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Departments of Neurobiology University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Departments of Psychiatry and Neurology, Rhode Island Hospital and Brown University, Providence, Rhode Island, USAVA Providence Healthcare System, Center for Neurorestoration and Neurotechnology, Providence, RI, USADepartments of Neurology University of Alabama at Birmingham (UAB), Birmingham, AL, USADepartments of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USADepartments of Neurology University of Alabama at Birmingham (UAB), Birmingham, AL, USAVA Providence Healthcare System, Center for Neurorestoration and Neurotechnology, Providence, RI, USAVA Providence Healthcare System, Center for Neurorestoration and Neurotechnology, Providence, RI, USA; Departments of Psychiatry and Neurology, Rhode Island Hospital and Brown University, Providence, Rhode Island, USADepartments of Neurology University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Departments of Neurobiology University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Departments of Neurosurgery University of Alabama at Birmingham (UAB), Birmingham, AL, USA; University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, USA; Corresponding authors at: UAB Epilepsy Center, University of Alabama at Birmingham, Department of Neurology, 1719 6th Avenue South, CIRC 312, Birmingham, AL 35249-0021, USA.Given the high prevalence of functional neurological symptom disorder and its negative effects on the individual, family, and society, the development of interventions to treat it—including the subtype of functional seizures (FS)—is critical. Although we have limited understanding of the neurobiological effects of neurobehavioral therapy (NBT), studies indicate that NBT reduces seizures and improves psychological comorbidities in FS. In this study, healthy adults (N = 33) and patients with a history of TBI with (TBI-FS; N = 50) and without FS (TBI-only; N = 50) underwent magnetic resonance imaging (MRI) at 3 T approximately 12 weeks apart. TBI-FS participants underwent up to 12 sessions of NBT between scans. Structural MRI data were analyzed using voxel-based morphometry. A voxelwise repeated measures ANOVA tested changes in grey matter volume (GMV) between groups over time. Following treatment with NBT, TBI-FS participants showed a 1.23 % GMV increase in the left inferior and middle temporal gyri (pFWE < 0.05) along with a 35.78 % reduction in seizure events and decrease in depressive (p < 0.001) and anxiety (p = 0.01) symptoms. Left temporal GMV increases were directly associated (p = 0.04, r = 0.26) with improvements in overall psychological, social, and occupational functioning (p < 0.001). We observed structural brain changes within the left inferior temporal gyrus following NBT that correspond to functional and psychological improvements in patients with TBI-FS. This work highlights the need for further research into the neurobiological effects of NBT, building on the relationship between NBT and brain plasticity and demonstrating putative targets for interventions.http://www.sciencedirect.com/science/article/pii/S2213158225000440Functional seizuresPsychogenic non-epileptic seizuresDissociative seizuresNeurobehavioral therapyGrey matter volumeNeuromorphometry
spellingShingle Ayushe A. Sharma
Jane B. Allendorfer
Stephen Correia
Tyler E. Gaston
Adam Goodman
Leslie E Grayson
Noah S. Philip
W. Curt LaFrance, Jr
Jerzy P. Szaflarski
Neuroplastic changes in patients with functional seizures following neurobehavioral therapy
NeuroImage: Clinical
Functional seizures
Psychogenic non-epileptic seizures
Dissociative seizures
Neurobehavioral therapy
Grey matter volume
Neuromorphometry
title Neuroplastic changes in patients with functional seizures following neurobehavioral therapy
title_full Neuroplastic changes in patients with functional seizures following neurobehavioral therapy
title_fullStr Neuroplastic changes in patients with functional seizures following neurobehavioral therapy
title_full_unstemmed Neuroplastic changes in patients with functional seizures following neurobehavioral therapy
title_short Neuroplastic changes in patients with functional seizures following neurobehavioral therapy
title_sort neuroplastic changes in patients with functional seizures following neurobehavioral therapy
topic Functional seizures
Psychogenic non-epileptic seizures
Dissociative seizures
Neurobehavioral therapy
Grey matter volume
Neuromorphometry
url http://www.sciencedirect.com/science/article/pii/S2213158225000440
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