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. 2022 Apr;34(4):e14271.
doi: 10.1111/nmo.14271. Epub 2021 Oct 4.

Children with chronic nausea and orthostatic intolerance have unique brain network organization: A case-control trial

John E Fortunato  1   2   3 , Paul J Laurienti  4 , Ashley L Wagoner  3 , Hossam A Shaltout  3 , Debra I Diz  3 , Jessy L Silfer  4 , Jonathan H Burdette  4
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Children with chronic nausea and orthostatic intolerance have unique brain network organization: A case-control trial

John E Fortunato et al. Neurogastroenterol Motil. 2022 Apr.

Abstract

Background: Determine whether subjects with chronic nausea and orthostatic intolerance share common alterations in key brain networks associated with central autonomic control: default mode, salience, and central executive networks, and the insula, a key component of the salience network.

Methods: Ten subjects (ages 12-18 years; 8 females, 2 males) with nausea predominant dyspepsia, orthostatic intolerance, and abnormal head-upright tilt test were consecutively recruited from pediatric gastroenterology clinic. These subjects were compared with healthy controls (n = 8) without GI symptoms or orthostatic intolerance. Resting-state fMRI and brain network modularity analyses were performed. Differences in the default mode, salience, and central executive networks, and insular connectivity were measured.

Key results: The community structure of the default mode network and salience network was significantly different between tilt-abnormal children and controls (p = 0.034 and 0.012, respectively), whereas, no group difference was observed in the central executive network (p = 0.48). The default mode network was more consistently "intact," and the consistency of the community structure in the salience network was reduced in tilt-abnormal children, especially in the insula.

Conclusions and inferences: Children with chronic nausea and orthostatic intolerance have altered connectivity in the default mode network and salience network/insula, which supports over-monitoring of their body and altered processing of bodily states resulting in interoceptive hyper self-awareness. The connectivity of the salience network would not support optimal regulation of appropriate attention to internal and external stimuli, and the hyper-connected default mode network may result in a persistent self-referential state with feelings of emotion, pain, and anxiety.

Trial registration: ClinicalTrials.gov NCT01692561.

Keywords: central executive networks; default mode network; fMRI; insula; nausea-predominant dyspepsia; orthostatic intolerance; salience network.

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References

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