IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, Le Tampon, France.
Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Université de Lyon, Lyon, France.
Hum Brain Mapp. 2019 Jun 15;40(9):2611-2622. doi: 10.1002/hbm.24548. Epub 2019 Feb 28.
Despite numerous studies suggesting the role of insular cortex in the control of autonomic activity, the exact location of cardiac motor regions remains controversial. We provide here a functional mapping of autonomic cardiac responses to intracortical stimulations of the human insula. The cardiac effects of 100 insular electrical stimulations into 47 epileptic patients were divided into tachycardia, bradycardia, and no cardiac response according to the magnitude of RR interval (RRI) reactivity. Sympathetic (low frequency, LF, and low to high frequency powers ratio, LF/HF ratio) and parasympathetic (high frequency power, HF) reactivity were studied using RRI analysis. Bradycardia was induced by 26 stimulations (26%) and tachycardia by 21 stimulations (21%). Right and left insular stimulations induced as often a bradycardia as a tachycardia. Tachycardia was accompanied by an increase in LF/HF ratio, suggesting an increase in sympathetic tone; while bradycardia seemed accompanied by an increase of parasympathetic tone reflected by an increase in HF. There was some left/right asymmetry in insular subregions where increased or decreased heart rates were produced after stimulation. However, spatial distribution of tachycardia responses predominated in the posterior insula, whereas bradycardia sites were more anterior in the median part of the insula. These findings seemed to indicate a posterior predominance of sympathetic control in the insula, whichever the side; whereas the parasympathetic control seemed more anterior. Dysfunction of these regions should be considered when modifications of cardiac activity occur during epileptic seizures and in cardiovascular diseases.
尽管有许多研究表明岛叶皮层在自主活动控制中的作用，但心脏运动区的确切位置仍存在争议。我们在此提供了人类岛叶皮质内刺激对自主心脏反应的功能映射。对 47 例癫痫患者的 100 次岛叶电刺激的心脏效应根据 RR 间期（RRI）反应性的幅度分为心动过速、心动过缓和无心脏反应。使用 RRI 分析研究了交感神经（低频、LF 和低至高频率功率比、LF/HF 比）和副交感神经（高频功率、HF）反应性。26 次刺激（26%）引起心动过缓，21 次刺激（21%）引起心动过速。右侧和左侧岛叶刺激同样引起心动过缓和心动过速。心动过速伴随着 LF/HF 比值的增加，表明交感神经张力增加；而心动过缓似乎伴随着 HF 的增加，表明副交感神经张力增加。刺激后心率增加或减少的岛叶亚区存在一些左右不对称。然而，心动过速反应的空间分布主要在前岛叶，而心动过缓部位在前岛叶中部的前侧更为常见。这些发现似乎表明，无论哪一侧，岛叶的交感神经控制都以前部为主；而副交感神经控制则更靠前。在癫痫发作期间和心血管疾病中发生心脏活动改变时，应考虑这些区域的功能障碍。
