A 29-year-old male presented with swollen gums and stomatitis for the past two months. History revealed that he had moved to the United States from India six years ago and had a first episode of generalized tonic-clonic seizure with confusion and loss of consciousness. Meningioma of the brain was diagnosed, and a Gamma Knife excision of the meningioma was planned. The patient refused to proceed with the surgery and came back to India for a second opinion. Upon repeat MRI scan, the neurosurgeon revised the diagnosis to neurocysticercosis (NCC), and the patient was treated with albendazole, prednisolone, and phenytoin and recovered completely. Hence an unnecessary brain surgery was avoided. The complaint of stomatitis and gingival hypertrophy was due to the side effects of phenytoin. NCC remains a major public health problem in developing countries, and it should be considered as a differential diagnosis in patients from NCC endemic regions.

Entrainment is the rhythmic coordination of movement with a signal or other person. Most studies on entrainment have looked at synchronization with auditory or visual signals, whereas much less is known about how entrainment emerges mutually between individuals, especially when they are in physical contact with one another. In this dissertation, I empirically explored dance partnering as an ecological model for understanding interpersonal entrainment through haptic interaction. I began by performing a statistical meta-analysis of functional neuroimaging articles devoted to the most common experimental paradigm for entrainment, namely externally-paced finger tapping to an acoustic rhythmic stimulus (Chapter 2). The results showed that the cerebellar vermis was a strong neural marker of entrainment, as it was more activated by externally-paced tapping than by self-paced tapping, whereas the basal ganglia was activated by both types of rhythmic movements. Next, I used functional magnetic resonance imaging (fMRI) with a group of participants trained at couple dancing in order to explore the neural basis of haptic mutual entrainment, with a focus on the dynamics of leading and following (Chapter 3). While mutual interaction overall engaged brain networks involved in somatosensation, internal-body sensation and social cognition, leading showed enhanced activity principally in areas for motor control and self-initiated action, whereas following showed enhanced activity mainly in sensory and social-cognition areas. Finally, I used 3D motion capture to explore multisensory coupling for mutual entrainment at the group level during folk dancing (Chapter 4). The results showed that dancers relied most extensively on haptic coupling to synchronize as a group, whereas auditory and visual coupling were dependent on the spatiotemporal context. These studies advance our understanding of the neural and behavioural mechanisms underlying joint actions in which entrainment emerges mutually through haptic interaction. / Thesis / Doctor of Philosophy (PhD) / Entrainment is the rhythmic coordination of movement with a signal or other person. Most studies on entrainment have looked at synchronization with auditory or visual signals, whereas much less is known about how entrainment emerges mutually between individuals, especially when they are in physical contact with one another. I began my research by performing a statistical analysis of the literature examining the brain basis of synchronization with auditory signals, identifying a key brain area for entrainment. Next, using a group of participants trained at couple dancing, I explored the brain areas engaged when two individuals in physical contact improvised movement together, focusing on who is leading or following the interaction. Finally, I explored how folk dancers use multiple sensory signals (auditory, visual and tactile) to synchronize as a group. These studies advance our understanding of the neural and behavioural mechanisms by which people mutually entrain through physical interaction.

Deafness has been associated with poor abilities to deal with digits in the context of arithmetic and memory, and language modality-specific differences in the phonological similarity of digits have been shown to influence short-term memory (STM). Therefore, the overall aim of the present thesis was to find out whether language modality-specific differences in phonological processing between sign and speech can explain why deaf signers perform at lower levels than hearing peers when dealing with digits. To explore this aim, the role of phonological processing in digit-based arithmetic and memory tasks was investigated, using both behavioural and neuroimaging methods, in adult deaf signers and hearing non-signers, carefully matched on age, sex, education and non-verbal intelligence. To make task demands as equal as possible for both groups, and to control for material effects, arithmetic, phonological processing, STM and working memory (WM) were all assessed using the same presentation and response mode for both groups. The results suggested that in digit-based STM, phonological similarity of manual numerals causes deaf signers to perform more poorly than hearing non-signers. However, for  digit-based WM there was no difference between the groups, possibly due to differences in allocation of resources during WM. This indicates that similar WM for the two groups can be generalized from lexical items to digits. Further, we found that in the present work deaf signers performed better than expected and on a par with hearing peers on all arithmetic tasks, except for multiplication, possibly because the groups studied here were very carefully matched. However, the neural networks recruited for arithmetic and phonology differed between groups. During multiplication tasks, deaf signers showed an increased  reliance on cortex of the right parietal lobe complemented by the left inferior frontal gyrus. In contrast, hearing non-signers relied on cortex of the left frontal and parietal lobes during multiplication. This suggests that while hearing non-signers recruit phonology-dependent arithmetic fact retrieval processes for multiplication, deaf signers recruit non-verbal magnitude manipulation processes. For phonology, the hearing non-signers engaged left lateralized frontal and parietal areas within the classical perisylvian language network. In deaf signers, however, phonological processing was limited to cortex of the left occipital lobe, suggesting that sign-based phonological processing does not necessarily activate the classical language network. In conclusion, the findings of the present thesis suggest that language modality-specific differences between sign and speech in different ways can explain why deaf signers perform at lower levels than hearing non-signers on tasks that include dealing with digits. / Dövhet har kopplats till bristande förmåga att hantera siffror inom områdena aritmetik och minne. Särskilt har språkmodalitetsspecifika skillnader i fonologisk likhet för siffror visat sig påverka korttidsminnet. Det övergripande syftet med den här avhandlingen var därför att undersöka om språkmodalitetsspecifika skillnader i fonologisk bearbetning mellan teckenoch talspråk kan förklara varför döva presterar sämre än hörande på sifferuppgifter. För att utforska det området undersöktes fonologisk bearbetning i sifferbaserade minnesuppgifter och aritmetik med hjälp av både beteendevetenskapliga metoder och hjärnavbildning hos grupper av teckenspråkiga döva och talspråkiga hörande som matchats noggrant på ålder, kön, utbildning och icke-verbal intelligens. För att testförhållandena skulle bli så likartade som möjligt för de båda grupperna, och för att förebygga materialeffekter, användes samma presentations- och svarssätt för båda grupperna. Resultaten visade att vid sifferbaserat korttidsminne påverkas de dövas prestation av de tecknade siffrornas fonologiska likhet. Däremot fanns det ingen skillnad mellan grupperna gällande sifferbaserat arbetsminne, vilket kan bero på att de båda grupperna fördelar sina kognitiva resurser på olika sätt. Dessutom fann vi att den grupp teckenspråkiga döva som deltog i studien presterade bättre på aritmetik än vad tidigare forskning visat och de skiljde sig bara från hörande på multiplikationsuppgifter, vilket kan bero på att grupperna var så noggrant matchade. Däremot fanns det skillnader mellan grupperna i vilka neurobiologiska nätverk som aktiverades vid aritmetik och fonologi. Vid multiplikationsuppgifter aktiverades cortex i höger parietallob och vänster frontallob för de teckenspråkiga döva, medan cortex i vänster frontal- och parietallob aktiverades för de talspråkiga hörande. Detta indikerar att de talspråkiga hörande förlitar sig på fonologiberoende minnesstrategier medan de teckenspråkiga döva förlitar sig på ickeverbal magnitudmanipulering och artikulatoriska processer. Under den fonologiska uppgiften aktiverade de talspråkiga hörande vänsterlateraliserade frontala och parietala områden inom det klassiska språknätverket. För de teckenspråkiga döva var fonologibearbetningen begränsad till cortex i vänster occipitallob, vilket tyder på att teckenspråksbaserad fonologi inte behöver aktivera det klassiska språknätverket. Sammanfattningsvis visar fynden i den här avhandlingen att språkmodalitetsspecifika skillnader mellan tecken- och talspråk på olika sätt kan förklara varför döva presterar sämre än hörande på vissa sifferbaserade uppgifter.

Achtsamkeit wird mit vielen positiven Effekten für das psychische Wohlbefinden assoziiert, wobei Fähigkeiten wie Emotionsregulation (ER) und soziale Kognition (SC) zu den wichtigsten Mechanismen gehören. In der vorliegenden Doktorarbeit wurde die Beziehung zwischen Achtsamkeit, ER und SC mit verschiedenen methodischen Ansätzen untersucht. In Studie I wurde mithilfe von Literatur und empirischen Modellen die Beziehung zwischen Achtsamkeit und ER ausgearbeitet und verschiedene psychologische und neurokognitive Mechanismen diskutiert. Studie II zielte darauf ab den ER-Mechanismus bei „Trait-Achtsamkeit“ zu entschlüsseln. Hier zeigte sich, dass es sowohl bei Probanden mit einer Borderline-Persönlichkeitsstörung als auch bei gesunden Teilnehmern einen mediierenden Effekt von Selbstmitgefühl gab, der Achtsamkeit mit ER-Merkmalen verband. Studie III untersuchte den Zusammenhang zwischen ER und SC mit Hilfe von Verhaltens- und Neuroimaging-Experimenten, mit Fokus auf dem Konzept der sozialen ER (die Fähigkeit, die Emotionen anderer zu modulieren). Es zeigte sich, dass bei der Regulierung der Emotionen anderer der eigene Stress reduziert wird, wobei wichtige "soziokognitive" Hirnregionen (z.B. Precuneus) an der Vermittlung dieser Effekte beteiligt sind. Studie IV untersuchte im Rahmen einer Neuroimaging-basierten randomisierten Kontrollstudie ER-Mechanismen während einer achtsamkeitsbasierten Intervention (MBI). Die Studie zeigte eine durch die MBI induzierte ER-Verhaltensplastizität im Gehirn, sowohl für die Eigen- als auch für die soziale ER. Ein Effekt im Vergleich zu SC (kognitive und emotionale Empathie) wurde nicht gezeigt. Unter Einbezug aller Ergebnisse wurde ein Modell postuliert, das den Austausch und die Regulierung von Emotionen im Kontext von sozialen Interaktionen integriert. Die Dissertation bietet neue Einblicke in die ER-Mechanismen der Achtsamkeit und beleuchtet die individuellen Determinanten sozialer Prozesse durch das Zusammenbringen von ER und SC. / Mindfulness, the capacity to fully attend to the present experience, has been linked to a myriad of mental health benefits, being abilities such as emotion regulation (ER) and social cognition (SC) of the main potential active mechanisms. The current doctorate thesis investigated the relationship between mindfulness and ER and SC using a range of methodological approaches from trait level individual differences to behavioral and brain mechanisms. Study one explored the relationship between mindfulness and ER by examining the diverse literature and empirical models, discussing different psychological and neuro-cognitive mechanisms. Study two intended to unravel the ER mechanism of trait mindfulness, showing in both borderline personality and healthy subjects the mediating effect of self-compassion linking mindfulness and ER traits. Study three further investigated the link between ER and SC using behavioral and neuro-imaging experiments, addressing the notion of social ER (the capacity to modulate others’ emotions). It showed that when regulating others’ emotions, an individual’s own distress is reduced, being key ‘sociocognitive’ brain regions (i.e. precuneus) engaged in mediating these effects. Study four investigated the fine-grained ER mechanisms of a mindfulness-based intervention (MBI), comparing the MBI with a reading group (READ), in the context of a neuroimaging-based randomized controlled trial. This study revealed ER brain behavioral plasticity induced by the MBI, for both self and social ER. It also showed a lack of effect over SC (cognitive and emotional empathy). Articulating overall findings, a model that integrates exchanges and regulation of emotions in the context of social interactions is proposed. The dissertation offers new insights into mindfulness’ ER mechanisms, from dispositions to neuro-behavioral levels, and also sheds light onto individual level determinants of social processes, linking ER and SC.

In den letzten Jahren wurde es dank der Entwicklung moderner Bildgebungsverfahren möglich, die neuronalen Korrelate kognitiver Arbeitsprozesse teilweise aufzudecken und immer besser zu verstehen. Durch diese Fortschritte ist es heute möglich, diese identifizierten Systeme im Rahmen der Erforschung psychiatrischer Erkrankungen auf Dysregulationen zu untersuchen. Dabei wird seit einigen Jahren der Suche nach Endophänotypen eine tragende Rolle zuteil. Endophänotypen befinden sich dabei intermediär zwischen dem klinischen Phänotyp und dem für die Krankheit kodierenden Genotyp. Ihre Identifizierung soll in Zukunft dazu beitragen, das nach neuesten Erkenntnissen nicht mehr aktuelle psychiatrische Klassifikationssystem zu reformieren und damit eine krankheitsgerechtere Einteilung der einzelnen Diagnosegruppen zu gewährleisten. In diesem Rahmen wurden in der hier vorliegenden Arbeit drei verschiedene neuronale Systeme, die dem Belohnungssystem, dem verbalen sowie visuell-räumlichen Arbeitsgedächtnis und den Aufmerksamkeitsprozessen zugrunde liegen, in Bezug auf ihre Relevanz als potentielle Endophänotypen getestet. 20 erstgradige Angehörige von schizophrenen Patienten unterzogen sich in diesem Zuge einer etwa einstündigen fMRT- Untersuchung, während der sie Aufgaben zur Aktivierung dieser neuronalen Netzwerke lösen sollten. Die dabei gemachten Funde indizieren Dysregulationen verschiedener neuronaler Areale während aller Aufgaben. In Bezug auf vorherige Studien zu Endophänotypen sowohl mit Angehörigen als auch mit Schizophrenen konnten diese Funde in den wissenschaftlichen Hintergrund eingeordnet werden. Dabei konnten einige vielversprechende Beobachtungen festgehalten werden. Es ergaben sich potentielle Endophänotypen in Bereichen neuronaler Hirnstrukturen, die der Verarbeitung von kognitiven Kontrollprozessen zugrunde liegen. Des Weiteren konnte eine Dysregulation vor allem des rechten anterioren Thalamus konstatiert werden. Auch Hyperaktivierungen in Arealen des PFCs und im prämotorischen Kortex konnten ebenfalls durch Funde anderer Studien bestätigt werden. Zusammenfassend stehen die wissenschaftlichen Forschungen zur Endophänotypenfrage wohl noch am Anfang eines langen, jedoch sehr vielversprechenden Weges, der die aktuellen Klassifikationssysteme in Zukunft revolutionieren könnte. Die ersten Schritte sind getan und müssen nun in weiteren, umfangreicheren und möglicherweise auch präziseren Studien fortgeführt werden.

A significant subset of women plagued with breast cancer continue to experience chronic neuropathic pain (CNP) long after undergoing cancer treatment. Medical interventions such as pharmacotherapy and/or surgery have been most widely used to abate painful symptoms with limited efficacy. Other alternatives are required given a heavy reliance on pharmaceuticals can lead to tolerance, dependence and severe side effects. Possibilities include cognitive behavioural therapy (CBT), physical therapy, and mindfulness interventions to supplement pharmacotherapies. Mindfulness practice in particular has been offered to a variety of chronic pain groups including breast cancer patients, however evidence is lacking to support its effectiveness in CNP for breast cancer survivors (BCS). The purpose of the present study was to explore the benefits a mindfulness-based stress reduction program (MBSR) may have on altering the underlying neuronal correlates linked with pain-related symptoms associated with CNP in BCS. The primary objective was to investigate how mindfulness training might possibly mediate the brain’s capacity for emotional reactivity, white matter integrity, and activation of the default mode network (DMN) and how these changes may correlate with levels of pain severity and pain interference, improving overall quality of life. To achieve these results, several brain imaging techniques were used in order to observe the correlation between the subjective experience of pain and the objective manifestation of brain changes that may be potentiated by MBSR training. A total of 23 participants were placed in either an 8 week MBSR intervention group (n=13) or a waitlist control group (n =10). All women were scanned with MRI before and after the 8 week intervention regardless of group allotment. The following neuroimaging modalities were used for each scanning session: resting state fMRI (rsfMRI) to monitor changes to functional connectivity in the default mode network (DMN); Diffusion Tensor Imaging (DTI) to assess the structural integrity of white matter tracts; and the Emotional Stroop Task (EST) to examine emotional reactivity in response to pain related stimuli. Exploratory results from this pilot study indicate that improvements to functional connectivity were apparent in the MBSR group relative to control, indicative of more efficient communication in areas related to attention, self-awareness, emotion regulation and pain. Improvements were also noted as increased cerebral white matter health and reduced emotional reactivity to pain related stimuli in the group of MBSR trained participants relative to control. Additionally, these functional and structural changes correlated with the self-reported pain measures in the MBSR group, suggesting that the MBSR group demonstrated improvements to ratings of pain severity and pain interference whereas the opposite occurred with the control group. The results have been interpreted as improvements to patients’ perception of pain and quality of life post MBSR training, however, were not limited to the subjective experience of pain. The inclusion of neuroimaging modalities provides objective and empirical support for MBSR training as it highlights the underlying brain mechanisms that were altered as part of MBSR treatment. Ultimately, the evidence suggests that MBSR could be incorporated as part of the treatment protocol for women experiencing CNP post breast cancer treatment.