Abstract
Patients with conversion disorder generally suffer from a severe neurological deficit which cannot be attributed to a structural neurological damage. In two patients with acute conversion paraplegia, investigation with functional magnetic resonance imaging (fMRI) showed that the insular cortex, a limbic-related cortex involved in body-representation and subjective emotional experience, was activated not only during attempt to move the paralytic body-parts, but also during mental imagery of their movements. In addition, mental rotation of affected body-parts was found to be disturbed, as compared to unaffected body parts or external objects. fMRI during mental rotation of the paralytic body-part showed an activation of another limbic related region, the anterior cingulate cortex. These data suggest that conversion paraplegia is associated with pathological activity in limbic structures involved in body representation and a deficit in mental processing of the affected body-parts.
Highlights
Conversion disorder (“hysteria”) is defined as neurological disturbances that cannot be attributed to neurological disease [1]
While comparing movements of the implicated body parts to non-implicated parts, we found bilateral activation of the insular cortex, with right predominance (p < 0.01; Figure 1A,B)
The areas that were activated during mental rotation of legs with respect to arms (p < 0.01) included the left inferior parietal and anterior cingualte cortex (ACC; Figure 2C)
Summary
Conversion disorder (“hysteria”) is defined as neurological disturbances that cannot be attributed to neurological disease [1]. The dorsolateral region of the prefrontal cortex showed decreased activity, together with a network composed of inferior parietal cortex, cerebellum, contralateral primary sensorimotor and premotor cortex, suggesting inhibition of a network involved in programming and execution of movement by the prefrontal cortex [6,13,14,15,16]. While these studies suggest certain cortices to play a central role in conversion disorder, it is still not clear how the mental disturbance underlying conversion leads to the neurological deficit. We hypothesized that paralysis was due to impairment in mental processing of the affected body-parts rather than motor execution
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