Altered sense of self during seizures in the posteromedial cortex.
Altered sense of self during seizures in the posteromedial cortex.
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DOI：
10.1073/pnas.2100522118
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发表时间：
2021-07-20
影响因子：
11.1
通讯作者：
Markert M
中科院分区：
文献类型：
--
作者：
Parvizi J;Braga RM;Kucyi A;Veit MJ;Pinheiro-Chagas P;Perry C;Sava-Segal C;Zeineh M;van Staalduinen EK;Henderson JM;Markert M
在这篇文章中，我们报告了一个罕见的情况下，患者的局部癫痫发作起源于右前和背后内侧皮质（PMC）。我们绘制了电生理和神经影像学连接的发作网站和复制癫痫发作先兆刺激同伦PMC网站在左半球。我们的研究结果提供了PMC和自我感之间的因果关系，并提供了独特的线索，自我分离的病理生理学在神经精神疾病。后内侧皮层（PMC）是默认模式网络的核心节点。鉴于其解剖位置和血液供应模式，有针对性地破坏这部分大脑的影响在很大程度上是未知的。在这里，我们报告了一个罕见的情况下，患者（S19_137）与确认癫痫发作起源于PMC。颅内记录证实了右侧背后扣带回皮质癫痫发作，邻近边缘沟，可能对应于Brodmann 31区。在癫痫发作时，患者报告了一种可再现的自我分离感-他将这种情况描述为对自己身体在空间中的位置的扭曲意识，感觉好像他暂时成为自己思想的外部观察者，他的“我”已经成为一个独立的实体，正在倾听他大脑的不同部分相互交谈。重要的是，50 Hz的电刺激癫痫发作区和对侧PMC内的同伦区域诱导了主观上相似的状态，可重复。我们补充我们的临床研究结果与患者的网络解剖的定义在感兴趣的网站使用皮质-皮质诱发电位，实验和静息状态电生理连接，和个人水平的功能成像。患者S19_137的这一罕见病例凸显了PMC对于整合自我参照信息的潜在因果重要性，并为未来神经精神人群自我解离的机制研究提供了线索。
In this manuscript, we report a rare case of a patient with localized seizures originating from the right anterior and dorsal posteromedial cortex (PMC). We mapped the electrophysiological and neuroimaging connectivity of the ictal onset site and replicated seizure auras by stimulating the homotopical PMC site in the left hemisphere. Our findings provide a causal link between PMC and the sense of self and provide unique clues about the pathophysiology of self-dissociation in neuropsychiatric conditions. The posteromedial cortex (PMC) is known to be a core node of the default mode network. Given its anatomical location and blood supply pattern, the effects of targeted disruption of this part of the brain are largely unknown. Here, we report a rare case of a patient (S19_137) with confirmed seizures originating within the PMC. Intracranial recordings confirmed the onset of seizures in the right dorsal posterior cingulate cortex, adjacent to the marginal sulcus, likely corresponding to Brodmann area 31. Upon the onset of seizures, the patient reported a reproducible sense of self-dissociation—a condition he described as a distorted awareness of the position of his body in space and feeling as if he had temporarily become an outside observer to his own thoughts, his “me” having become a separate entity that was listening to different parts of his brain speak to each other. Importantly, 50-Hz electrical stimulation of the seizure zone and a homotopical region within the contralateral PMC induced a subjectively similar state, reproducibly. We supplement our clinical findings with the definition of the patient’s network anatomy at sites of interest using cortico-cortical–evoked potentials, experimental and resting-state electrophysiological connectivity, and individual-level functional imaging. This rare case of patient S19_137 highlights the potential causal importance of the PMC for integrating self-referential information and provides clues for future mechanistic studies of self-dissociation in neuropsychiatric populations.
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DOI：
10.1073/pnas.1721714115
发表时间：
2018-05-01
影响因子：
11.1
作者：
Daitch, Amy L.;Parvizi, Josef
通讯作者：
Parvizi, Josef
影响因子：
2.5
作者：
AGGLETON, JP;DESIMONE, R;MISHKIN, M
通讯作者：
MISHKIN, M
影响因子：
64.8
作者：
Blanke, O;Ortigue, S;Seeck, M
通讯作者：
Seeck, M
影响因子：
5.7
作者：
Fransson, Peter;Marrelec, Guillaume
通讯作者：
Marrelec, Guillaume
影响因子：
5.7
作者：
Fischl, Bruce
通讯作者：
Fischl, Bruce