Facial Emotion Processing Changes in Functional Seizures after Neurobehavioral Therapy (P12-8.008)

Abstract

<h3>Objective:</h3> To prospectively investigate effects of neurobehavioral therapy (NBT) on fMRI emotion processing in adults with psychogenic non-epileptic (functional) seizures (FS). <h3>Background:</h3> 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. <h3>Design/Methods:</h3> 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&lt;0.05), fMRI signal was extracted, and correlations performed (Bonferroni-corrected p&lt;0.0125). <h3>Results:</h3> 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&lt;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). <h3>Conclusions:</h3> 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. <b>Disclosure:</b> Dr. Szaflarski has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB Pharma. Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for SK Life Sciences. Dr. Szaflarski has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for LivaNova Inc. Dr. Szaflarski has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Serina Therapeutics. Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GW Biosciences. An immediate family member of Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GW Biosciences. Dr. Szaflarski has received personal compensation in the range of $500-$4,999 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. An immediate family member of Dr. Allendorfer has received personal compensation for serving as an employee of Northport Health Services, LLC. Dr. Allendorfer has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Liva Nova, Inc. The institution of Dr. Allendorfer has received research support from National Institutes of Health. Dr. Allendorfer has a non-compensated relationship as a Grants Reviewer with American Epilepsy Society that is relevant to AAN interests or activities. Dr. Goodman has nothing to disclose. Rodolphe Nenert, 4770 has nothing to disclose. Dr. Gaston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GW Biosciences. 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 . The institution of Dr. Philip has received research support from NIH, DoD, VA. Stephen Correia has received research support from Alzheimer’s Association/National Institute on Aging. Stephen Correia has received research support from NIMH. 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.