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

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. Children with chronic nausea and orthostatic intolerance with abnormal tilt‐table testing have disrupted connectivity in the default mode network and salience network/insula. This supports over‐monitoring of their body and altered processing of bodily states resulting in interoceptive hyper self‐awareness. This may lead to a persistent self‐referential state with feelings of emotion, pain, and anxiety. The connectivity of the salience network would not support optimal regulation of appropriate attention to internal and external stimuli.