Impaired cardiac modulation in patients with functional seizures: Results from a face intensity judgment task

Objective: Although interoceptive abnormality in patients with functional seizure (FSs) has been demonstrated using explicit tasks, implicit measurements of interoception such as the effect of interoception on perceptual brain processes have not been investigated. It has been shown that perception is normally modulated by interoceptive signals related to the different phases (systole vs diastole) of the cardiac cycle (cardiac modulation effect). Given our previous findings using explicit measures of interoception, we hypothesized that cardiac modulation would be impaired in FSs.

Methods: Thirty-two patients with FSs and 30 age- and sex-matched non-clinical individuals conducted a face intensity judgment task, in which their intensity rating when fearful or neutral faces was presented was compared between systolic and diastolic phases. They also conducted the heartbeat discrimination task as a measure of their capacity to integrate both interoceptive and exteroceptive information.

Results: Patients with FSs had impaired cardiac modulation of the perception of neutral faces (corrected p =.044). Individual differences in the heartbeat discrimination task predicted the degree to which cardiac modulation occurred across the whole group (p =.028). This cardiac modulation effect was significantly associated with seizure severity (p =.021). Regardless of cardiac phase, patients rated fearful facial expressions as less intense compared to control participants (p =.006).

Significance: These findings highlight impaired implicit cardiac modulation effects in patients with FSs. This reflects interoceptive dysfunction in patients with FSs, and an inability of the brain to integrate interoceptive signaling with perceptual processing. This may have implications for our understanding of the pathophysiology in FSs and inform novel diagnostic approaches.