Estradiol modulates changes in effective connectivity in emotion regulation networks.

Hormonal changes in ovarian hormones like estradiol (E2) during the menstrual cycle affect emotional processes, including emotion recognition, memory, and regulation. So far, the neural underpinnings of the effect of E2 on emotional experience have been investigated using task-based functional magnetic resonance imaging (fMRI) and functional connectivity. In the present study, we examined whether the intrinsic network dynamics at rest (i.e., directed effective connectivity) related to emotion regulation are (1) modulated by E2 levels and (2) linked to behavioral emotion regulation ability. Hence, 29 naturally cycling women participated in two resting-state fMRI scans in their early follicular phase after being administered a placebo or an E2 valerate, respectively. Emotion regulation ability was assessed using a standard emotion regulation task in which participants were asked to down-regulate their emotions in response to negative images. The regions of two functionally predefined neural networks related to emotional down-regulation and reactivity were used to investigate effective connectivity at rest using spectral dynamic causal modelling. We found that E2, compared to placebo, resulted in changes in effective connectivity in both networks. In the regulation network, prefrontal regions showed distinct connectivity in the E2 compared to the placebo condition, while mixed results evolved in the emotional reactivity network. Stepwise regressions revealed that in the E2 condition a connection from the parietal to the prefrontal cortex predicted regulation ability. Our results demonstrate that E2 levels influence effective connectivity in networks underlying emotion regulation and emotional reactivity. Thus, E2 and its potential modification via hormonal administration may play a supporting role in the treatment of mental disorders that show a dysregulation of emotions.

Neural patterns during anticipation predict emotion regulation success for reappraisal.

The ability to exert control over emotions, termed emotion regulation (ER), is vital for everyday functioning. ER success may be influenced by processes relating to the anticipation (prior to active regulation) and implementation (during active regulation) of ER strategy use. We investigated whether brain activity patterns recorded using electroencephalography (EEG) during the first second of anticipation and implementation of two ER strategies-distraction and reappraisal-were related to regulation success. Participants viewed negative images that evoked disgust and sadness. Before each image was presented, participants were cued to either passively view the image or decrease their emotional responses. ER success scores were calculated from subsequent self-reported disgust and sadness ratings. Using multivariate support vector regression, ER success scores were predicted from spatiotemporal patterns of event-related potentials during the first second of anticipation and implementation phases of each ER strategy. For both sadness and disgust, reappraisal success could be predicted during anticipation, while distraction success could be predicted during implementation. These findings suggest that early anticipatory cognitive processes are a key determinant of reappraisal success, but may not be similarly important for distraction. This may be because reappraisal is more cognitively demanding than distraction, requiring enhanced preparation of mental resources.

Epilepsy in an elderly patient caused by Hashimoto's encephalopathy.

Late-onset seizures are frequently caused by cerebrovascular disease, head trauma, degenerative disorders or CNS tumors. In one-third of cases, the etiology remains obscure. In only 60-70% of adult-onset epilepsy is antiepileptic drug treatment successful. Although seizures are a well-known symptom of Hashimoto's encephalopathy, it is rarely taken into consideration as differential diagnosis in epilepsy. We describe a 74-year-old patient with seizures and slowly progressive cognitive deterioration. Previous therapeutic attempts with carbamazepine, lamotrigine and topiramate had not been effective. We suspected Hashimoto's encephalopathy, which was treated with prednisolone 100 mg/d over 6 months. This regimen led to a cessation of the complex partial seizures and cognitive improvement. We conclude that Hashimoto's encephalopathy is a possible differential diagnosis in epilepsy in the elderly. Glucocorticoid treatment should be considered if there are no important contraindications.