Limbic and paralimbic structures driving ictal central apnea
Limbic and paralimbic structures driving ictal central apnea
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DOI：
10.1212/wnl.0000000000006920
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发表时间：
2019-02-12
期刊：
影响因子：
9.9
通讯作者：
Lhatoo, Samden
中科院分区：
文献类型：
--
作者：
Lacuey, Nuria;Hampson, Johnson P.;Lhatoo, Samden
目的精确识别调节呼吸的皮质区域，并描绘癫痫发作期间中枢呼吸暂停（ICA）的皮质结构网络。方法对癫痫术前行立体定向脑电图（SEEG）评估的患者进行脑皮层多结构电刺激。研究的结构包括眶额皮质、前、后扣带和胼胝体下回、岛、海马、海马旁回、杏仁核、颞极皮质、前-中膜梭状回、外侧和基底颞皮质。连续监测胸/腹带胸/腹运动、外周毛细血管血氧饱和度、末潮和经皮二氧化碳以及气流。结果连续调查18 ~ 69岁成人患者19例，其中女性10例。在13/19的患者中，杏仁核、海马头体、海马前旁回和中前梭状回诱发了短暂性中枢性呼吸暂停。刺激岛叶、扣带、胼胝体下、眶额、外侧和基底颞叶皮质不会引起呼吸暂停。呼吸暂停持续时间与刺激持续时间（p < 0.001）和电流强度（p = 0.004）相关。结论：这些发现提示了一个边缘/旁边缘近缘颞叶呼吸调节网络，包括杏仁核、海马、前海马旁和前近缘梭状回。这些结构可能代表了ICA的解剖和功能基础，ICA是一种假定的癫痫猝死（SUDEP）呼吸生物标志物。已知这些区域的损伤发生在SUDEP高风险患者和SUDEP受害者中，并且可能支持被认为特别危险的长期ICA。此外，SEEG植入中产生呼吸暂停的结构的包容性靶向，周周呼吸信号记录，以及癫痫符号学中对呼吸暂停序列的严格分析，可能会提高癫痫手术中对症状源性和癫痫发作区域的准确识别。
ObjectiveTo precisely identify cortical regions that modulate breathing, and delineate a network of cortical structures that underpin ictal central apnea (ICA) during epileptic seizures.MethodsWe electrically stimulated multiple cortical structures in patients undergoing stereotactic EEG (SEEG) evaluation before epilepsy surgery. Structures investigated were orbitofrontal cortex, anterior and posterior cingulate and subcallosal gyri, insula, hippocampus, parahippocampal gyrus, amygdala, temporo-polar cortex, antero-mesial fusiform gyrus, and lateral and basal temporal cortices. Chest/abdominal excursions using thoracic/abdominal belts, peripheral capillary oxygen saturation, end tidal and transcutaneous carbon dioxide, and airflow were continuously monitored.ResultsNineteen consecutive adult patients (10 female) aged 18-69 years were investigated. Transient central apnea was elicited in 13/19 patients with amygdala, hippocampus head and body, anterior parahippocampal gyrus, and antero-mesial fusiform gyrus. Insula, cingulate, subcallosal, orbitofrontal, lateral, and basal temporal cortices stimulation did not induce apnea. Apnea duration was associated with stimulus duration (p < 0.001) and current intensity (p = 0.004).ConclusionsThese findings suggest a limbic/paralimbic mesial temporal breathing modulation network that includes amygdala, hippocampus, anterior parahippocampal, and antero-mesial fusiform gyri. These structures likely represent anatomical and functional substrates for ICA, a putative sudden unexpected death in epilepsy (SUDEP) breathing biomarker. Damage to such areas is known to occur in high SUDEP risk patients and SUDEP victims, and may underpin the prolonged ICA that is thought to be particularly dangerous. Furthermore, inclusive targeting of apnea-producing structures in SEEG implantations, peri-ictal breathing signal recordings, and stringent analysis of apneic sequences in seizure semiology may enhance accurate identification of symptomatogenic and seizure onset zones for epilepsy surgery.