{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:25:05Z","timestamp":1783743905530,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T00:00:00Z","timestamp":1635897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["5T32NS061788\u201014"],"award-info":[{"award-number":["5T32NS061788\u201014"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Psychogenic nonepileptic seizures (PNES) are characterized by multifocal and global abnormalities in brain function and connectivity. Only a few studies have examined neuroanatomic correlates of PNES. Traumatic brain injury (TBI) is reported in 83% of patients with PNES and may be a key component of PNES pathophysiology. In this study, we included patients with TBI preceding the onset of PNES (TBI\u2010PNES) and TBI without PNES (TBI\u2010only) to identify neuromorphometric abnormalities associated with PNES.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adults diagnosed with TBI\u2010PNES (<jats:italic>n<\/jats:italic>\u00a0=\u00a062) or TBI\u2010only (<jats:italic>n<\/jats:italic>\u00a0=\u00a059) completed psychological questionnaires and underwent 3\u2010T magnetic resonance imaging. Imaging data were analyzed by voxel\u2010 and surface\u2010based morphometry. Voxelwise general linear models computed group differences in gray matter volume, cortical thickness, sulcal depth, fractal dimension (FDf), and gyrification. Statistical models were assessed with permutation\u2010based testing at 5000 iterations with the Threshold\u2010Free Cluster Enhancement toolbox. Logarithmically scaled <jats:italic>p<\/jats:italic>\u2010values corrected for multiple comparisons using familywise error were considered significant at <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.05. Post hoc analyses determined the association between structural and psychological measures (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>TBI\u2010PNES participants demonstrated atrophy of the left inferior frontal gyrus and the right cerebellum VIII. Relative to TBI\u2010only, TBI\u2010PNES participants had decreased FDf in the right superior parietal gyrus and decreased sulcal depth in the left insular cortex. Significant clusters were positively correlated with global assessment of functioning scores, and demonstrated varying negative associations with measures of anxiety, depression, somatization, and global severity of symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>The diagnosis of PNES was associated with brain atrophy and reduced cortical folding in regions implicated in emotion processing, regulation, and response inhibition. Cortical folds primarily develop during the third trimester of pregnancy and remain relatively constant throughout the remainder of one\u2019s life. Thus, the observed aberrations in FDf and sulcal depth could originate early in development. The convergence of environmental, developmental, and neurobiological factors may coalesce to reflect the neuropathophysiological substrate of PNES.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17109","type":"journal-article","created":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T10:57:21Z","timestamp":1635937041000},"page":"222-236","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Regional brain atrophy and aberrant cortical folding relate to anxiety and depression in patients with traumatic brain injury and psychogenic nonepileptic seizures"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8194-2232","authenticated-orcid":false,"given":"Ayushe A.","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Neurology University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7550-679X","authenticated-orcid":false,"given":"Adam M.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane B.","family":"Allendorfer","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"University of Alabama at Birmingham Epilepsy Center  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah S.","family":"Philip","sequence":"additional","affiliation":[{"name":"Veterans Affairs Rehabilitation, Research, &amp; Development Center for Neurorestoration and Neurotechnology  Providence Rhode Island USA"},{"name":"Department of Psychiatry and Human Behavior Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Correia","sequence":"additional","affiliation":[{"name":"Veterans Affairs Rehabilitation, Research, &amp; Development Center for Neurorestoration and Neurotechnology  Providence Rhode Island USA"},{"name":"Department of Psychiatry and Human Behavior Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4901-3852","authenticated-orcid":false,"suffix":"Jr.","given":"W. 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