Altered resting-state functional activity in posttraumatic stress disorder: A quantitative meta-analysis.

Ting Wang,Graham J Kemp,Jia Liu,Qiyong Gong,Hongyan Zhu,Min Wu,Wang Zhan,Hua Huang,Lei Li,Junran Zhang

doi:10.1038/srep27131

Abstract

Many functional neuroimaging studies have reported differential patterns of spontaneous brain activity in posttraumatic stress disorder (PTSD), but the findings are inconsistent and have not so far been quantitatively reviewed. The present study set out to determine consistent, specific regional brain activity alterations in PTSD, using the Effect Size Signed Differential Mapping technique to conduct a quantitative meta-analysis of resting-state functional neuroimaging studies of PTSD that used either a non-trauma (NTC) or a trauma-exposed (TEC) comparison control group. Fifteen functional neuroimaging studies were included, comparing 286 PTSDs, 203 TECs and 155 NTCs. Compared with NTC, PTSD patients showed hyperactivity in the right anterior insula and bilateral cerebellum, and hypoactivity in the dorsal medial prefrontal cortex (mPFC); compared with TEC, PTSD showed hyperactivity in the ventral mPFC. The pooled meta-analysis showed hypoactivity in the posterior insula, superior temporal, and Heschl’s gyrus in PTSD. Additionally, subgroup meta-analysis (non-medicated subjects vs. NTC) identified abnormal activation in the prefrontal-limbic system. In meta-regression analyses, mean illness duration was positively associated with activity in the right cerebellum (PTSD vs. NTC), and illness severity was negatively associated with activity in the right lingual gyrus (PTSD vs. TEC).

Highlights

IntroductionPublished studies differ considerably in sample size, the demographic and clinical characteristics of the patients, differential levels in baseline activity and in the imaging protocols used
The result confirmed a subset of regional differences that have frequently been reported in previous Posttraumatic stress disorder (PTSD) studies, including hyperactive anterior insula and hypoactive dorsal medial prefrontal cortex (dmPFC) in PTSD patients compared with NTC, and hyperactive vmPFC in PTSD compared with TEC
The results confirmed a subset of consistent regional differences often reported in previous PTSD studies, including the vmPFC, insula, and limbic regions

Summary

Introduction

Published studies differ considerably in sample size, the demographic and clinical characteristics of the patients, differential levels in baseline activity and in the imaging protocols used. Another factor, often overlooked, is the use of different control groups: neuroimaging findings in PTSD may be compared to individuals without any history of trauma exposure (‘non-trauma controls’, NTC) or to individuals with a history of trauma exposure who have not developed PTSD (‘trauma-exposed controls’, TEC), and clearly these two comparisons have different pathophysiological implications. We used a voxel-based meta-analytic technique, Effect Size Signed Differential Mapping (ES-SDM), to identify consistent functional brain alterations in PTSD by integrating the full range of studies reporting resting regional brain activity. We performed meta-regression analysis to examine the potential effects of age, illness severity and illness duration of PTSD patients

Methods

Results

Discussion

Conclusion