Title
Motor inhibition in hysterical conversion paralysis.
Abstract
Brain mechanisms underlying hysterical conversion symptoms are still poorly known. Recent hypotheses suggested that activation of motor pathways might be suppressed by inhibitory signals based on particular emotional situations. To assess motor and inhibitory brain circuits during conversion paralysis, we designed a go–nogo task while a patient underwent functional magnetic resonance imaging (fMRI). Preparatory activation arose in right motor cortex despite left paralysis, indicating preserved motor intentions, but with concomitant increases in vmPFC regions that normally mediate motivational and affective processing. Failure to execute movement on go trials with the affected left hand was associated with activations in precuneus and ventrolateral frontal gyrus. However, right frontal areas normally subserving inhibition were activated by nogo trials for the right (normal) hand, but not during go trials for the left hand (affected by conversion paralysis). By contrast, a group of healthy controls who were asked to feign paralysis showed similar activation on nogo trials and left-go trials with simulated weakness, suggesting that distinct inhibitory mechanisms are implicated in simulation and conversion paralysis. In the patient, right motor cortex also showed enhanced functional connectivity with the posterior cingulate cortex, precuneus, and vmPFC. These results suggest that conversion symptoms do not act through cognitive inhibitory circuits, but involve selective activations in midline brain regions associated with self-related representations and emotion regulation.
Year
DOI
Venue
2009
10.1016/j.neuroimage.2009.05.023
NeuroImage
Keywords
Field
DocType
Inhibition,Conversion paralysis,Go–nogo,Precuneus,vmPFC,Connectivity
Cortex (botany),Developmental psychology,Precuneus,Neuroscience,Functional magnetic resonance imaging,Psychology,Inhibitory postsynaptic potential,Posterior cingulate,Cognition,Paralysis,Frontal gyrus
Journal
Volume
Issue
ISSN
47
3
1053-8119
Citations 
PageRank 
References 
6
0.52
9
Authors
4
Name
Order
Citations
PageRank
Yann Cojan181.29
Lakshmi Waber260.52
Alain Carruzzo360.52
P Vuilleumier443540.82