Lai George, Langevin Jean-Philippe, Koek Ralph J, Krahl Scott E, Bari Ausaf A, Chen James W Y
Neurology Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.
Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States.
Front Hum Neurosci. 2020 Feb 25;14:61. doi: 10.3389/fnhum.2020.00061. eCollection 2020.
Accurate localization of complex human experiences such as emotions, dreaming, creativity, and consciousness to specific cerebral structures or neural networks has remained elusive despite technological advances. We report the use of acute deep brain stimulation (DBS) to evoke behavioral and emotional effects by applying electrical stimulation (ES) at various voltage strengths to the basolateral and central subnuclei of the amygdala in addition to the head of hippocampus (HC) for two subjects with medically refractory post-traumatic stress disorder (PTSD). Our results suggest that the amygdala could be a node in a neural network responsible for the generation of complex vivid mental imagery and integrated sensory experiences similar to John Hughlings Jackson's "dreamy state" and "double consciousness," which have been classically associated with temporal lobe epilepsy during uncinate seizures. That we were able to elicit similar vivid, dynamic, complex, bizarre, and original mental imagery with ES in non-epileptic subjects suggests that Jackson's seizure related "dreamy state" and "double consciousness" may arise from heightened innate brain mechanisms with the amygdala acting as a node in the neural network responsible for physiologic dreaming and creative functions. Furthermore, our subjects experienced different emotions with different stimulation strengths at various electrode contacts. Our results suggest that higher voltage stimulation of the amygdala and HC at 4-5 V leads to predominantly negative responses and 2-4 V stimulation showed inversely coupled positive and negative responses of the amygdala in either hemisphere which may imply hemispheric dominance of emotional valences without relation to handedness. Due to the unique and complex responses dependent on location and strength of stimulation, we advise that all patients receiving DBS of the amygdala undergo acute stimulation mapping in a monitored setting before selecting therapeutic parameters for chronic stimulation.
尽管技术不断进步，但将诸如情绪、梦境、创造力和意识等复杂的人类体验精确地定位到特定的脑结构或神经网络仍然难以实现。我们报告了对两名患有难治性创伤后应激障碍（PTSD）的受试者使用急性深部脑刺激（DBS），通过在不同电压强度下对杏仁核的基底外侧和中央亚核以及海马头部（HC）施加电刺激（ES）来诱发行为和情绪效应。我们的结果表明，杏仁核可能是神经网络中的一个节点，负责产生复杂生动的心理意象和综合的感官体验，类似于约翰·胡克林·杰克逊的“梦幻状态”和“双重意识”，这些在经典上与钩回发作期间的颞叶癫痫有关。我们能够在非癫痫受试者中通过电刺激诱发类似的生动、动态、复杂、奇异和原始的心理意象，这表明杰克逊与癫痫发作相关的“梦幻状态”和“双重意识”可能源于大脑先天机制的增强，杏仁核作为神经网络中的一个节点，负责生理梦境和创造性功能。此外，我们的受试者在不同电极触点处以不同刺激强度体验到了不同的情绪。我们的结果表明，在4 - 5伏对杏仁核和海马进行较高电压刺激主要导致负面反应，而2 - 4伏刺激显示杏仁核在任一半球的正负反应呈反向耦合，这可能意味着情绪效价的半球优势与利手无关。由于存在依赖于刺激位置和强度的独特而复杂的反应，我们建议所有接受杏仁核DBS治疗的患者在选择慢性刺激的治疗参数之前，在监测环境中进行急性刺激图谱绘制。
