Abstract Details

Title Facial Emotion Processing Changes in Functional Seizures after Neurobehavioral Therapy

Topic Neuro-rehabilitation

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-008

Objective

To prospectively investigate effects of neurobehavioral therapy (NBT) on fMRI emotion processing in adults with psychogenic non-epileptic (functional) seizures (FS).

Background

NBT reduces FS frequency and affects emotion processing in people with FS. We hypothesized that changes in FS frequency, mood symptoms and overall functioning with NBT would be associated with changes in emotion processing.

Design/Methods Adults with FS after traumatic brain injury (TBI+FS; n=47) underwent a 12-sessions of NBT. TBI+FS and TBI-only controls (n=57) completed two fMRIs and assessments of depression (BDI-II), anxiety (BAI), and Global Assessment of Functioning (GAF) about 12 weeks apart (V1; V2). Subjects performed the emotion faces task (EFT) during fMRI where they viewed happy, sad, fearful and neutral faces. Linear mixed effects assessed group-by-time interactions on emotion response (corrected p<0.05), fMRI signal was extracted, and correlations performed (Bonferroni-corrected p<0.0125).

Results

53% of TBI+FS were seizure-free following NBT. There were significant group-by-time interactions (V1-to-V2 increases in TBI+FS and decreases in TBI-only) for fMRI response within right middle frontal gyrus (RMFG) to happy, sad, and fearful faces, and right inferior frontal gyrus (RIFG) to fearful faces. In combined sample, there were negative correlations between V2-V1 BDI-II changes and RMFG response changes to happy (rho=-0.30, p=0.003) and sad faces (rho=-0.27, p=0.008), and positive correlations between V2-V1 GAF changes and RMFG response changes to happy (rho=0.34, p<0.001) and sad faces (rho=0.31, p=0.001), and RIFG response changes to fearful faces (rho=0.26, p=0.008). There were non-significant trends in TBI+FS for relationship between percent FS reduction and RMFG response changes to happy (rho=-0.24, p=0.106) and sad faces (rho=-0.24, p=0.109).

Conclusions

We observed strong relationships in the combined group between behavioral changes and fMRI changes. The observed seizure reduction was not correlated with imaging changes suggesting that factors other than seizure reduction may be driving post-NBT changes in facial emotion processing.

Authors/Disclosures
Jerzy P. Szaflarski, MD, PhD, FAAN (University of Alabama At Birmingham) PRESENTER	Dr. Szaflarski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Szaflarski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LivaNova Inc. Dr. Szaflarski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PureTech Health. Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Gidley, Sarli & Marusak, LLP. Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firm. Dr. Szaflarski has stock in AdCel Biopharma, LLC. Dr. Szaflarski has stock in iFovea.
Jane B. Allendorfer, PhD (U of Alabama At Birmingham, Neurology)	The institution of Dr. Allendorfer has received research support from National Institutes of Health. The institution of Dr. Allendorfer has received research support from Evelyn F. McKnight Brain Institute. The institution of Dr. Allendorfer has received research support from LivaNova, Inc. Dr. Allendorfer has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Cleveland Clinic. Dr. Allendorfer has received personal compensation in the range of $0-$499 for serving as a Examiner with University of Auckland. Dr. Allendorfer has received personal compensation in the range of $500-$4,999 for serving as a Speaker with International League Against Epilepsy. Dr. Allendorfer has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Department of Defense. Dr. Allendorfer has a non-compensated relationship as a Scientific Program Committee Member with American Epilepsy Society that is relevant to AAN interests or activities. Dr. Allendorfer has a non-compensated relationship as a Editorial Board Member with Epilepsy and Behavior Reports that is relevant to AAN interests or activities.
	No disclosure on file
Rodolphe Nenert	Rodolphe Nenert has nothing to disclose.
Tyler E. Gaston, MD	Dr. Gaston has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurelis. The institution of Dr. Gaston has received research support from NINDS.
Leslie E. Perry Grayson, MD (Mission Medical Associates)	Dr. Perry Grayson has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Jazz Pharmaceuticals . The institution of Dr. Perry Grayson has received research support from Department of Defense .
	No disclosure on file
	No disclosure on file
W. C. LaFrance, Jr., MD, MPH, FAAN (Rhode Island Hospital)	Dr. LaFrance has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medico-legal work.. The institution of Dr. LaFrance has received research support from Department of Defense. Dr. LaFrance has received publishing royalties from a publication relating to health care. Dr. LaFrance has received publishing royalties from a publication relating to health care. Dr. LaFrance has a non-compensated relationship as a Steering Committee Member with Xenon that is relevant to AAN interests or activities.

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