Emilia Toth1, Ganne Chaitanya2, Michael Pogwizd3, Diana Pizarro1, Adeel Ilyas4, Steven Pogwizd5, Sandipan Pati6. 1. Department of Neurology, University of Alabama at Birmingham, 1719, 6th Avenue South, Birmingham, AL, 35294-3410, USA. 2. Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India. 3. Department of Mathematics, University of Alabama at Birmingham, Birmingham, AL, USA. 4. Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA. 5. Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. 6. Department of Neurology, University of Alabama at Birmingham, 1719, 6th Avenue South, Birmingham, AL, 35294-3410, USA. spati@uabmc.edu.
Abstract
PURPOSE: Arousal is the most primitive, powerful instinct with survival benefit present in all vertebrates. Even though the arousal systems are classically viewed as "ascending" brainstem phenomena, there is a "descending" cortical feedback system that maintains consciousness. In this study, we provide electrophysiological confirmation that seizures localized to the anterior cingulum can behaviorally manifest as paroxysms of arousal from sleep. METHODS: Temporal dynamics of arousal induced by anterior cingulate seizures were analyzed by using multiple modalities including stereoelectroencephalography (phase lag index and phase amplitude coupling), lead-1 ECG (point-process heart rate variability analysis) and diffusion tractography (DTI). RESULTS: The ictal arousal was associated with an increase in synchronization in the alpha band and an increase in local theta or alpha-gamma phase-amplitude coupling. In comparison to seizures that lacked clinical manifestations, ictal arousal was associated with an increase in heart rate but not heart rate variability. Finally, DTI demonstrated degeneration in white fiber tracts passing between the anterior cingulum and anterior thalamus ipsilateral to the epileptogenic cortex. The patient underwent resection of the anterior cingulum, and histopathology confirmed focal cortical dysplasia type II. CONCLUSION: Anterior cingulate seizures inducing behavioral arousal have identifiable autonomic and EEG signatures.
PURPOSE: Arousal is the most primitive, powerful instinct with survival benefit present in all vertebrates. Even though the arousal systems are classically viewed as "ascending" brainstem phenomena, there is a "descending" cortical feedback system that maintains consciousness. In this study, we provide electrophysiological confirmation that seizures localized to the anterior cingulum can behaviorally manifest as paroxysms of arousal from sleep. METHODS: Temporal dynamics of arousal induced by anterior cingulate seizures were analyzed by using multiple modalities including stereoelectroencephalography (phase lag index and phase amplitude coupling), lead-1 ECG (point-process heart rate variability analysis) and diffusion tractography (DTI). RESULTS: The ictal arousal was associated with an increase in synchronization in the alpha band and an increase in local theta or alpha-gamma phase-amplitude coupling. In comparison to seizures that lacked clinical manifestations, ictal arousal was associated with an increase in heart rate but not heart rate variability. Finally, DTI demonstrated degeneration in white fiber tracts passing between the anterior cingulum and anterior thalamus ipsilateral to the epileptogenic cortex. The patient underwent resection of the anterior cingulum, and histopathology confirmed focal cortical dysplasia type II. CONCLUSION: Anterior cingulate seizures inducing behavioral arousal have identifiable autonomic and EEG signatures.
Authors: R Vetrugno; M Mascalchi; A Vella; R Della Nave; F Provini; G Plazzi; D Volterrani; P Bertelli; A Vattimo; E Lugaresi; P Montagna Journal: Neurology Date: 2005-01-25 Impact factor: 9.910
Authors: Hugo D Critchley; Christopher J Mathias; Oliver Josephs; John O'Doherty; Sergio Zanini; Bonnie-Kate Dewar; Lisa Cipolotti; Tim Shallice; Raymond J Dolan Journal: Brain Date: 2003-06-23 Impact factor: 13.501
Authors: Shih-Chieh Lin; Ritchie E Brown; Marshall G Hussain Shuler; Carl C H Petersen; Adam Kepecs Journal: J Neurosci Date: 2015-10-14 Impact factor: 6.167