Gschwind Markus, Picard Fabienne
Department of Neurology, University Hospital and Medical School of GenevaGeneva, Switzerland; Functional Brain Mapping Laboratory, Department of Neuroscience, Biotech Campus, University of GenevaGeneva, Switzerland.
Department of Neurology, University Hospital and Medical School of Geneva Geneva, Switzerland.
Front Behav Neurosci. 2016 Feb 17;10:21. doi: 10.3389/fnbeh.2016.00021. eCollection 2016.
Ecstatic epileptic seizures are a rare but compelling epileptic entity. During the first seconds of these seizures, ecstatic auras provoke feelings of well-being, intense serenity, bliss, and "enhanced self-awareness." They are associated with the impression of time dilation, and can be described as a mystic experience by some patients. The functional neuroanatomy of ecstatic seizures is still debated. During recent years several patients presenting with ecstatic auras have been reported by others and us (in total n = 52); a few of them in the setting of presurgical evaluation including electrical brain stimulation. According to the recently recognized functions of the insula, and the results of nuclear brain imaging and electrical stimulation, the ecstatic symptoms in these patients seem to localize to a functional network centered around the anterior insular cortex, where we thus propose to locate this rare ictal phenomenon. Here we summarize the role of the multiple sensory, autonomic, affective, and cognitive functions of the insular cortex, which are integrated into the creation of self-awareness, and we suggest how this system may become dysfunctional on several levels during ecstatic aura.
狂喜性癫痫发作是一种罕见但引人关注的癫痫类型。在这些发作的最初几秒内，狂喜性先兆会引发幸福感、强烈的宁静感、极乐感以及“增强的自我意识”。它们伴有时间膨胀的感觉，一些患者将其描述为一种神秘体验。狂喜性发作的功能性神经解剖学仍存在争议。近年来，其他研究者和我们（总计n = 52）都报告了数例出现狂喜性先兆的患者；其中一些患者处于术前评估阶段，包括脑电刺激。根据最近认识到的脑岛功能，以及核脑成像和电刺激的结果，这些患者的狂喜症状似乎定位于以脑岛前皮质为中心的一个功能网络，因此我们建议将这种罕见的发作现象定位于此。在此，我们总结了脑岛皮质的多种感觉、自主神经、情感和认知功能在自我意识形成过程中的作用，并提出在狂喜性先兆期间该系统可能在多个层面出现功能障碍的方式。
