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

John E. Fortunato*, Paul J. Laurienti, Ashley L. Wagoner, Hossam A. Shaltout, Debra I. Diz, Jessy L. Silfer, Jonathan H. Burdette

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article numbere14271
JournalNeurogastroenterology and Motility
Volume34
Issue number4
DOIs
StatePublished - Apr 2022

Keywords

  • central executive networks
  • default mode network
  • fMRI
  • insula
  • nausea-predominant dyspepsia
  • orthostatic intolerance
  • salience network

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Fingerprint

Dive into the research topics of 'Children with chronic nausea and orthostatic intolerance have unique brain network organization: A case-control trial'. Together they form a unique fingerprint.

Cite this