title: Structural brain abnormalities in postural tachycardia syndrome: A VBM-DARTEL study.
abstract: Postural tachycardia syndrome (PoTS), a form of dysautonomia, is characterized by orthostatic intolerance, and is frequently accompanied by a range of symptoms including palpitations, lightheadedness, clouding of thought, blurred vision, fatigue, anxiety, and depression. Although the estimated prevalence of PoTS is approximately 5-10 times as common as the better-known condition orthostatic hypotension, the neural substrates of the syndrome are poorly characterized. In the present study, we used magnetic resonance imaging (MRI) with voxel-based morphometry (VBM) applying the diffeomorphic anatomical registration through exponentiated lie algebra (DARTEL) procedure to examine variation in regional brain structure associated with PoTS. We recruited 11 patients with established PoTS and 23 age-matched normal controls. Group comparison of gray matter volume revealed diminished gray matter volume within the left anterior insula, right middle frontal gyrus and right cingulate gyrus in the PoTS group. We also observed lower white matter volume beneath the precentral gyrus and paracentral lobule, right pre- and post-central gyrus, paracentral lobule and superior frontal gyrus in PoTS patients. Subsequent ROI analyses revealed significant negative correlations between left insula volume and trait anxiety and depression scores. Together, these findings of structural differences, particularly within insular and cingulate components of the salience network, suggest a link between dysregulated physiological reactions arising from compromised central autonomic control (and interoceptive representation) and increased vulnerability to psychiatric symptoms in PoTS patients.
authors: Department of Psychology, Keio University Tokyo, Japan ; Autonomic Unit, National Hospital for Neurology and Neurosurgery, University College London London, UK.
authors: Satoshi
authors: S
authors: Umeda
authors: Department of Psychiatry, Brighton and Sussex Medical School, University of Sussex Brighton, UK ; Sussex Partnership NHS Foundation Trust Brighton, UK ; Sackler Centre for Consciousness Science, University of Sussex Brighton, UK.
authors: Neil A
authors: NA
authors: Harrison
authors: Centre for Advanced Imaging, The University of Queensland St. Lucia, QLD, Australia ; Royal Brisbane and Women's Hospital Herston, QLD, Australia.
authors: Marcus A
authors: MA
authors: Gray
authors: Autonomic Unit, National Hospital for Neurology and Neurosurgery, University College London London, UK ; Neurovascular Medicine, Imperial College London at St. Mary's Hospital London, UK.
authors: Christopher J
authors: CJ
authors: Mathias
authors: Department of Psychiatry, Brighton and Sussex Medical School, University of Sussex Brighton, UK ; Sussex Partnership NHS Foundation Trust Brighton, UK ; Sackler Centre for Consciousness Science, University of Sussex Brighton, UK.
authors: Hugo D
authors: HD
authors: Critchley
keywords: VBM-DARTEL; anxiety; autonomic disorders; depression; insula; interoception; postural tachycardia syndrome; salience network