Department of Neurology, University of Alabama at Birmingham, 1719, 6th Avenue South, Birmingham, AL, 35294-3410, USA.
Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India.
Clin Auton Res. 2019 Apr;29(2):205-209. doi: 10.1007/s10286-018-0543-x. Epub 2018 Jul 14.
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.
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).
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.
Anterior cingulate seizures inducing behavioral arousal have identifiable autonomic and EEG signatures.
觉醒是所有脊椎动物都具有的最原始、最强大的生存本能。尽管觉醒系统通常被视为“上行”脑干现象，但存在一个“下行”皮质反馈系统来维持意识。在这项研究中，我们提供了电生理学证据，证明局部在前扣带回的癫痫发作可以表现为睡眠中觉醒的阵发性发作。
通过使用包括立体脑电图（相位滞后指数和相位振幅耦合）、导联 1 ECG（点过程心率变异性分析）和弥散张量成像（DTI）在内的多种模态来分析前扣带回癫痫发作引起的觉醒的时间动态。
发作性觉醒与 alpha 波段的同步性增加以及局部 theta 或 alpha-gamma 相位-幅度耦合增加有关。与没有临床表现的癫痫发作相比，发作性觉醒与心率增加有关，但与心率变异性无关。最后，DTI 显示在致痫皮层同侧的前扣带回和前丘脑之间的白质纤维束退化。患者接受了前扣带回切除术，组织病理学证实为 II 型局灶性皮质发育不良。
引起行为觉醒的前扣带回癫痫发作具有可识别的自主神经和 EEG 特征。
