Machine learning classification of functional neurological disorder using structural brain MRI features.

Autor:	Westlin C; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA dlperez@nmr.mgh.harvard.edu cwestlin@mgh.harvard.edu.; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Guthrie AJ; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Paredes-Echeverri S; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Maggio J; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA., Finkelstein S; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Godena E; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Millstein D; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., MacLean J; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA., Ranford J; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA., Freeburn J; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA., Adams C; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Stephen C; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Movement Disorders Division, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Diez I; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Perez DL; Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA dlperez@nmr.mgh.harvard.edu cwestlin@mgh.harvard.edu.; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	Journal of neurology, neurosurgery, and psychiatry [J Neurol Neurosurg Psychiatry] 2024 Jul 20. Date of Electronic Publication: 2024 Jul 20.
DOI:	10.1136/jnnp-2024-333499
Abstrakt:	Background: Brain imaging studies investigating grey matter in functional neurological disorder (FND) have used univariate approaches to report group-level differences compared with healthy controls (HCs). However, these findings have limited translatability because they do not differentiate patients from controls at the individual-level. Methods: 183 participants were prospectively recruited across three groups: 61 patients with mixed FND (FND-mixed), 61 age-matched and sex-matched HCs and 61 age, sex, depression and anxiety-matched psychiatric controls (PCs). Radial basis function support vector machine classifiers with cross-validation were used to distinguish individuals with FND from HCs and PCs using 134 FreeSurfer -derived grey matter MRI features. Results: Patients with FND-mixed were differentiated from HCs with an accuracy of 0.66 (p=0.005; area under the receiving operating characteristic (AUROC)=0.74); this sample was also distinguished from PCs with an accuracy of 0.60 (p=0.038; AUROC=0.56). When focusing on the functional motor disorder subtype (FND-motor, n=46), a classifier robustly differentiated these patients from HCs (accuracy=0.72; p=0.002; AUROC=0.80). FND-motor could not be distinguished from PCs, and the functional seizures subtype (n=23) could not be classified against either control group. Important regions contributing to statistically significant multivariate classifications included the cingulate gyrus, hippocampal subfields and amygdalar nuclei. Correctly versus incorrectly classified participants did not differ across a range of tested psychometric variables. Conclusions: These findings underscore the interconnection of brain structure and function in the pathophysiology of FND and demonstrate the feasibility of using structural MRI to classify the disorder. Out-of-sample replication and larger-scale classifier efforts incorporating psychiatric and neurological controls are needed. Competing Interests: Competing interests: DLP has received honoraria for continuing medical education lectures in FND; royalties from Springer for a functional movement disorder textbook and honoraria from Elsevier for a functional neurological disorder textbook; is on the editorial boards of Brain and Behavior (paid), Epilepsy & Behavior, The Journal of Neuropsychiatry and Clinical Neurosciences and Cognitive and Behavioral Neurology; has previously received funding from the Sidney R. Baer Jr. Foundation unrelated to this work and is on the FND Society Board, American Neuropsychiatric Association Advisory Council and the FND Hope International Medical Advisory Board. All other authors report no conflicts of interest/disclosures. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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