Abstract Background In myoclonus dystonia (DYT‐ SGCE ) psychiatric features such as anxiety and depression are frequent comorbidities. The neural mechanisms underlying these negative emotional states in DYT‐ SGCE remain poorly understood. Task‐based functional magnetic resonance imaging (fMRI), by measuring task‐evoked functional connectivity during emotion processing, offers mechanistic insight into the pathophysiology of nonmotor features in DYT‐ SGCE . Objective The aim was to investigate effective connectivity alterations in the neural network associated with the experience of negative emotions in DYT‐ SGCE . We hypothesized that patients show impaired regulation of negative emotions due to altered connectivity between the nonmotor cerebellum and its associated cortical regions. Methods DYT‐ SGCE patients and healthy volunteers (HV) performed an fMRI task involving conscious recall of personal emotional experiences under stressful and neutral‐relaxing conditions. An emotional network was identified using data‐driven activation maps, and generalized psychophysiological interactions were applied to compare connectivity modulation between conditions across groups. Results Twenty DYT‐ SGCE patients and 20 HVs were enrolled in the study. DYT‐ SGCE patients exhibited increased connectivity from the cerebellum to the precuneus, medial prefrontal, and middle temporal cortices during the stressful condition compared to the neutral‐relaxing condition. Clinically, DYT‐ SGCE patients showed higher anxiety scores. Across groups, higher trait of anxiety was associated with further amplification of cerebello‐cortical connectivity in these regions, but severity of anxiety was not directly correlated with connectivity in patients. No changes in connectivity or correlations with anxiety were observed for cortico‐cerebellar, cerebello‐cerebellar, or cortico‐cortical connections. Conclusions These findings emphasize the role of the cerebellum in emotional regulation dysfunction in DYT‐ SGCE , which may underlie the patients' psychiatric phenotype. © 2026 International Parkinson and Movement Disorder Society.
Tarrano et al. (Mon,) studied this question.