{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:08:00Z","timestamp":1792012080228,"version":"4.4.0"},"reference-count":37,"publisher":"BMJ","issue":"9","funder":[{"name":"NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Association of British Neurologists and Patrick Berthoud Charitable Trust","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100022431","name":"Medical Research Council Centre for Neurodevelopmental Disorders","doi-asserted-by":"publisher","award":["MR\/N026063\/1"],"award-info":[{"award-number":["MR\/N026063\/1"]}],"id":[{"id":"10.13039\/501100022431","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MRC CARP award MR\/V037676\/1"],"award-info":[{"award-number":["MRC CARP award MR\/V037676\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2023,4,5]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with functional seizures (FS) can experience dissociation (depersonalisation) before their seizures. Depersonalisation reflects disembodiment, which may be related to changes in interoceptive processing. The heartbeat-evoked potential (HEP) is an electroencephalogram (EEG) marker of interoceptive processing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess whether alterations in interoceptive processing indexed by HEP occur prior to FS and compare this with epileptic seizures (ES).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>HEP amplitudes were calculated from EEG during video-EEG monitoring in 25 patients with FS and 19 patients with ES, and were compared between interictal and preictal states. HEP amplitude difference was calculated as preictal HEP amplitude minus interictal HEP amplitude. A receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of HEP amplitude difference in discriminating FS from ES.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The FS group demonstrated a significant reduction in HEP amplitude between interictal and preictal states at F8 (effect size rB=0.612, false discovery rate (FDR)-corrected q=0.030) and C4 (rB=0.600, FDR-corrected q=0.035). No differences in HEP amplitude were found between states in the ES group. Between diagnostic groups, HEP amplitude difference differed between the FS and ES groups at F8 (rB=0.423, FDR-corrected q=0.085) and C4 (rB=0.457, FDR-corrected q=0.085). Using HEP amplitude difference at frontal and central electrodes plus sex, we found that the ROC curve demonstrated an area under the curve of 0.893, with sensitivity=0.840\u2009and specificity=0.842.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our data support the notion that aberrant interoception occurs prior to FS. Changes in HEP amplitude may reflect a neurophysiological biomarker of FS and may have diagnostic utility in differentiating FS and ES.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnnp-2022-330167","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T17:20:58Z","timestamp":1685035258000},"page":"769-775","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Changes in the heartbeat-evoked potential are associated with functional seizures"],"prefix":"10.1136","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0352-4016","authenticated-orcid":false,"given":"Samia","family":"Elkommos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Martin-Lopez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0132-9724","authenticated-orcid":false,"given":"Akihiro","family":"Koreki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Jolliffe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Kandasamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9415-3395","authenticated-orcid":false,"given":"Marco","family":"Mula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo D","family":"Critchley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Garfinkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark P","family":"Richardson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahinda","family":"Yogarajah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,25]]},"reference":[{"key":"2024102910301109000_94.9.769.1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12356"},{"key":"2024102910301109000_94.9.769.2","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16949"},{"key":"2024102910301109000_94.9.769.3","doi-asserted-by":"crossref","unstructured":"Asadi-Pooya AA . Incidence and prevalence of psychogenic nonepileptic seizures (functional seizures): a systematic review and an analytical study. Int J Neurosci 2021:1\u20136. doi:10.1080\/00207454.2021.1942870","DOI":"10.1080\/00207454.2021.1942870"},{"key":"2024102910301109000_94.9.769.4","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.yebeh.2015.03.015","article-title":"Epidemiology of psychogenic nonepileptic seizures","volume":"46","author":"Asadi-Pooya","year":"2015","journal-title":"Epilepsy Behav"},{"key":"2024102910301109000_94.9.769.5","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2021-326443"},{"key":"2024102910301109000_94.9.769.6","doi-asserted-by":"crossref","first-page":"e643","DOI":"10.1212\/WNL.0000000000009855","article-title":"Mortality in patients with psychogenic nonepileptic seizures","volume":"95","author":"Nightscales","year":"2020","journal-title":"Neurology"},{"key":"2024102910301109000_94.9.769.7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.yebeh.2019.03.016","article-title":"Morbidity and mortality of nonepileptic seizures (nes): a controlled national study","volume":"96","author":"Jennum","year":"2019","journal-title":"Epilepsy Behav"},{"key":"2024102910301109000_94.9.769.8","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.yebeh.2015.07.016","article-title":"Thoughts, emotions, and dissociative features differentiate patients with epilepsy from patients with psychogenic nonepileptic spells (pness)","volume":"51","author":"Hendrickson","year":"2015","journal-title":"Epilepsy Behav"},{"key":"2024102910301109000_94.9.769.9","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/nyas.13915","article-title":"The neurobiology of interoception in health and disease","volume":"1428","author":"Quadt","year":"2018","journal-title":"Ann N Y Acad Sci"},{"key":"2024102910301109000_94.9.769.10","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2011.00395"},{"key":"2024102910301109000_94.9.769.11","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16532"},{"key":"2024102910301109000_94.9.769.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2020.12.012"},{"key":"2024102910301109000_94.9.769.13","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.neuroimage.2018.11.037","article-title":"Focus of attention modulates the heartbeat evoked potential","volume":"186","author":"Petzschner","year":"2019","journal-title":"Neuroimage"},{"key":"2024102910301109000_94.9.769.14","doi-asserted-by":"crossref","unstructured":"Kumar M. A , R. S , Kumar TVS . Proceedings of international conference on advances in computing. New Delhi, 2012. doi:10.1007\/978-81-322-0740-5","DOI":"10.1007\/978-81-322-0740-5"},{"key":"2024102910301109000_94.9.769.15","doi-asserted-by":"crossref","DOI":"10.1038\/srep32390","article-title":"Prediction of ventricular tachycardia one hour before occurrence using artificial neural networks","volume":"6","author":"Lee","year":"2016","journal-title":"Sci Rep"},{"key":"2024102910301109000_94.9.769.16","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000195"},{"key":"2024102910301109000_94.9.769.17","doi-asserted-by":"publisher","DOI":"10.1016\/0168-5597(93)90001-6"},{"key":"2024102910301109000_94.9.769.18","doi-asserted-by":"publisher","DOI":"10.1016\/0301-0511(95)05147-3"},{"key":"2024102910301109000_94.9.769.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-5597(98)00003-3"},{"key":"2024102910301109000_94.9.769.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2019.02.002"},{"key":"2024102910301109000_94.9.769.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1756-8765.2012.01189.x"},{"key":"2024102910301109000_94.9.769.22","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1080\/17470218.2016.1181768","article-title":"The multisensory basis of the self: from body to identity to others [formula: see text]","volume":"70","author":"Tsakiris","year":"2017","journal-title":"Q J Exp Psychol (Hove)"},{"key":"2024102910301109000_94.9.769.23","doi-asserted-by":"publisher","DOI":"10.1038\/nrn2555"},{"key":"2024102910301109000_94.9.769.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2013.02.008"},{"key":"2024102910301109000_94.9.769.25","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1177\/1747021819879826","article-title":"Testing the independence of self-reported interoceptive accuracy and attention","volume":"73","author":"Murphy","year":"2020","journal-title":"Q J Exp Psychol (Hove)"},{"key":"2024102910301109000_94.9.769.26","doi-asserted-by":"publisher","DOI":"10.1111\/1469-8986.2004.00170.x"},{"key":"2024102910301109000_94.9.769.27","doi-asserted-by":"publisher","DOI":"10.1126\/science.1143439"},{"key":"2024102910301109000_94.9.769.28","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.0311-16.2016"},{"key":"2024102910301109000_94.9.769.29","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhx136"},{"key":"2024102910301109000_94.9.769.30","doi-asserted-by":"publisher","DOI":"10.1177\/1754073911430135"},{"key":"2024102910301109000_94.9.769.31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0089823","article-title":"Striking discrepancy of anomalous body experiences with normal interoceptive accuracy in depersonalization-derealization disorder","volume":"9","author":"Michal","year":"2014","journal-title":"PLoS One"},{"key":"2024102910301109000_94.9.769.32","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.20121"},{"key":"2024102910301109000_94.9.769.33","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1098\/rstb.2016.0018","article-title":"Neural correlates of heart-focused interoception: a functional magnetic resonance imaging meta-analysis","volume":"371","author":"Schulz","year":"2016","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"2024102910301109000_94.9.769.34","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-4388(03)00090-4"},{"key":"2024102910301109000_94.9.769.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2013.09.007"},{"key":"2024102910301109000_94.9.769.36","doi-asserted-by":"publisher","DOI":"10.1038\/nrn3950"},{"key":"2024102910301109000_94.9.769.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2018.08.008"}],"container-title":["Journal of Neurology, Neurosurgery &amp; Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jnnp-2022-330167","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T17:30:38Z","timestamp":1730223038000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnnp.bmj.com\/lookup\/doi\/10.1136\/jnnp-2022-330167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,25]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,26]]},"published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1136\/jnnp-2022-330167"],"URL":"https:\/\/doi.org\/10.1136\/jnnp-2022-330167","relation":{},"ISSN":["0022-3050","1468-330X"],"issn-type":[{"value":"0022-3050","type":"print"},{"value":"1468-330X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,25]]}}}