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Rigshospitalet - a part of Copenhagen University Hospital
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Functional neuroimaging of recovery from motor conversion disorder: A case report

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A patient with motor conversion disorder presented with a functional paresis of the left hand. After exclusion of structural brain damage, she was repeatedly examined with whole-brain functional magnetic resonance imaging, while she performed visually paced finger-tapping tasks. The dorsal premotor cortex showed a bilateral deactivation in the acute-subacute phase. Recovery from unilateral hand paresis was associated with a gradual increase in task-based activation of the dorsal premotor cortex bilaterally. The right medial prefrontal cortex displayed the opposite pattern, showing initial task-based activation that gradually diminished with recovery. The inverse dynamics of premotor and medial prefrontal activity over time were found during unimanual finger-tapping with the affected and non-affected hand as well as during bimanual finger-tapping. These observations suggest that reduced premotor and increased medial prefrontal activity reflect an effector-independent cortical dysfunction in conversion paresis which gradually disappears in parallel with clinical remission of paresis. The results link the medial prefrontal and dorsal premotor areas to the generation of intentional actions. We hypothesise that an excessive 'veto' signal generated in medial prefrontal cortex along with decreased premotor activity might constitute the functional substrate of conversion disorder. This notion warrants further examination in a larger group of affected patients.

Original languageEnglish
JournalNeuroImage
Volume190
Pages (from-to)269-274
Number of pages6
ISSN1053-8119
DOIs
Publication statusPublished - 15 Apr 2019

Bibliographical note

Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

    Research areas

  • Journal Article, Review, fMRI, Inhibition of intentional actions, Conversion disorder, Motor, Dorsal premotor cortex (PMd), Medial prefrontal cortex (mPFC), Recovery

ID: 58702054