Gustatory and olfactory responses to stimulation of the human insula

COVID-19 is associated with changes in brain function and structure: a multimodal meta-analysis of neuroimaging studies

The actual role of coronavirus disease 2019 (COVID-19) in brain damage has been increasingly reported, necessitating a meta-analysis to collate and summarize the inconsistent findings from functional imaging and voxel-based morphometry (VBM) studies. A comprehensive voxel-wise meta-analysis of the whole brain was conducted to identify alterations in functional activity and gray matter volume (GMV) between COVID-19 patients and healthy controls (HCs) by using Seed-based d Mapping software. We included 15 functional imaging studies (484 patients with COVID-19, 534 HCs) and 9 VBM studies (449 patients with COVID-19, 388 HCs) in the analysis. Overall, patients with COVID-19 exhibited decreased functional activity in the right superior temporal gyrus (STG) (extending to the right middle and inferior temporal gyrus, insula, and temporal pole [TP]), left insula, right orbitofrontal cortex (OFC) (extending to the right olfactory cortex), and left cerebellum compared to HCs. For VBM, patients with COVID-19, relative to HCs, showed decreased GMV in the bilateral anterior cingulate cortex/medial prefrontal cortex (extending to the bilateral OFC), and left cerebellum, and increased GMV in the bilateral amygdala (extending to the bilateral hippocampus, STG, TP, MTG, and right striatum). Moreover, overlapping analysis revealed that patients with COVID-19 exhibited both decreased functional activity and increased GMV in the right TP (extending to the right STG). The multimodal meta-analysis suggests that brain changes of function and structure in the temporal lobe, OFC and cerebellum, and functional or structural alterations in the insula and the limbic system in COVID-19. These findings contribute to a better understanding of the pathophysiology of brain alterations in COVID-19. SIGNIFICANCE STATEMENT: This first large-scale multimodal meta-analysis collates existing neuroimaging studies and provides voxel-wise functional and structural whole-brain abnormalities in COVID-19. Findings of this meta-analysis provide valuable insights into the dynamic brain changes (from infection to recovery) and offer further explanations for the pathophysiological basis of brain alterations in COVID-19.

What do brain oscillations tell about the human sense of smell?

Brain activity may manifest itself as oscillations which are repetitive rhythms of neuronal firing. These local field potentials can be measured via intracranial electroencephalography (iEEG). This review focuses on iEEG used to map human brain structures involved in olfaction. After presenting the methodology of the review, a summary of the brain structures involved in olfaction is given, followed by a review of the literature on human olfactory oscillations in different contexts. A single case is provided as an illustration of the olfactory oscillations. Overall, the timing and sequence of oscillations found in the different structures of the olfactory system seem to play an important role for olfactory perception.

Interoceptive abilities impairment correlates with emotional eating and taste abnormalities in children with overweight and obesity

Weight problems in children are associated with emotional eating, which has been linked to interoceptive abilities. Previous research also shows altered olfactory and gustatory perception in children with obesity and overweight. Therefore, we aimed to investigate the connection of alterations in olfactory and gustatory perception to interoceptive abilities and emotional eating among children with obesity and overweight. 23 children with overweight and obesity and age-matched controls with normal weight (12-16 years old) underwent olfactory and gustatory testing. Interoceptive abilities were assessed, focusing on interoceptive accuracy and interoceptive sensibility. Children with overweight and obesity showed significantly higher accuracy for detection of sweet taste, but descriptively lower accuracy for all other taste qualities compared to normal weight children. We found no changes in olfactory abilities in children with overweight and obesity. Emotional eating scores were elevated for children with overweight and obesity, and interoceptive accuracy scores were significantly lower. In both groups, interoceptive accuracy was inversely correlated with emotional eating. Our results support prior findings of altered gustatory abilities in children with overweight and obesity. The observed link between impaired interoceptive processes and heightened emotional eating in this group implies that interventions for overweight in children could benefit from targeting interoceptive abilities. This study provides meaningful grounds for further investigations into the roles of taste, emotional eating, and interoceptive abilities for overweight in children and adolescents.

Differences in olfactory functional connectivity in early-onset depression and late-onset depression

Background

Late-onset depression (LOD) and early-onset depression (EOD) exhibit different pathological mechanisms and clinical phenotypes, including different extents of olfactory dysfunction. However, the brain abnormalities underlying the differences in olfactory dysfunction between EOD and LOD remain unclear.

Objective

The aim of this study was to compare the functional connectivity (FC) patterns of olfactory regions between EOD patients and LOD patients and examine their relationship with cognitive function.

Methods

One hundred and five patients with EOD, 101 patients with LOD and 160 normal controls (NCs) were recruited for the present study. Participants underwent clinical assessment, olfactory testing, cognitive assessments, and magnetic resonance imaging. Eight regions of the primary and secondary olfactory regions were selected to investigate olfactory FC.

Results

Patients with LOD exhibited decreased odor identification (OI) compared with patients with EOD and NCs. The LOD group exhibited decreased FC compared with the EOD and NC groups when primary and secondary olfactory regions were selected as the regions of interest (the piriform cortex, lateral entorhinal cortex, and orbital-frontal cortex). Additionally, these abnormal olfactory FCs were associated with decreased cognitive function scores and OI, and the FC between the left orbital-frontal cortex and left amygdala was a partial mediator of the relationship between global cognitive scores and OI.

Conclusion

Overall, patients with LOD exhibited decreased FC in both the primary and secondary olfactory cortices compared with patients with EOD, and abnormal olfactory FC was associated with OI dysfunction and cognitive impairment. The FC between the orbital-frontal cortex and amygdala mediated the relationship between global cognitive function and OI.

Subjective states induced by intracranial electrical stimulation matches the cytoarchitectonic organization of the human insula

Functions of the human insula have been explored extensively with neuroimaging methods and intracranial electrical stimulation studies that have highlighted a functional segregation across its subregions. A recently developed cytoarchitectonic map of the human insula has also segregated this brain region into various areas. Our knowledge of the functional organization of this brain region at the level of these fine-parceled microstructural areas remains only partially understood. We address this gap of knowledge by applying a multimodal approach linking direct electrical stimulation and task-evoked intracranial EEG recordings with microstructural subdivisions of the human insular cortex. In 17 neurosurgical patients with 142 implanted electrodes, stimulation of 40 % of the sites induced a reportable change in the conscious experience of the subjects in visceral/autonomic, anxiety, taste/olfactory, pain/temperature as well as somatosensory domains. These subjective responses showed a topographical allocation to microstructural areas defined by probabilistic cytoarchitectonic parcellation maps of the human insula. We found the pain and thermal responses to be located in areas lg2/ld2, while non-painful/non-thermal somatosensory responses corresponded to area ld3 and visceroceptive responses to area Id6. Lastly, the stimulation of area Id7 in the dorsal anterior insula, failed to induce reportable changes to subjective experience even though intracranial EEG recordings from this region captured significant time-locked high-frequency activity (HFA). Our results provide a multimodal map of functional subdivisions within the human insular cortex at the individual brain basis and characterize their anatomical association with fine-grained cytoarchitectonic parcellations of this brain structure.

Abnormal visual and olfactory sensations during radiation therapy: a prospective study

PURPOSE

Patients sometimes report phosphene and phantosmia during radiation therapy (RT). However, the detail features and related factors are not well understood. Our prospective study aimed to investigate the characteristics of phantosmias and phosphenes, to identify factors that influence the occurrence, intensity and hedonic (pleasantness/unpleasantness) ratings of such sensations during RT.

METHODS

We included a total of 106 patients (37 women), who underwent RT in regions of the brain, ear, nose, throat (ENT), and other areas of the body for a duration of 43 ± 5 days. Medical history and treatment parameters were collected in a structured medical interview. Olfactory function was measured using the Sniffin' Stick Odor Identification Test at baseline. Phantosmia and phosphene were recorded weekly based on a self-report questionnaire.

RESULTS

There were 37% of the patients experiencing phantosmias, 51% experiencing phosphenes, and 29% simultaneously experiencing both sensations. Phosphenes were typically perceived as a flashily blue, white and/or purple light, phantosmias were typically perceived as a chemical-like, metallic or burnt smell. Younger age (F = 7.81, p < 0.01), radiation in the brain region (χ2 = 14.05, p = 0.02), absence of taste problems (χ2 = 10.28, p = 0.01), and proton RT (χ2 = 10.57, p = 0.01) were related to these abnormal sensations. History of chemical/dust exposure predicted lower intensity (B = -1.52, p = 0.02) and lower unpleasantness (B = 0.49, p = 0.03) of phantosmia. In contrast, disease (tumor) duration (B = 0.11, p < 0.01), food allergy (B = 2.77, p < 0.01), and epilepsy (B = -1.50, p = 0.02) influence phosphenes intensity. Analgesics intake predicted a higher pleasantness of the phosphenes (B = 0.47, p < 0.01).

CONCLUSIONS

Phantosmias and phosphenes are common during RT. The treatment settings and individual arousal level influence the occurrence, intensity and hedonic of such abnormal sensations. Phantosmias and phosphenes may involve more central neural than peripheral mechanism, and they could be elicited with activation of areas that are not regarded to be part of the olfactory or visual network.

Future therapeutic strategies for olfactory disorders: electrical stimulation, stem cell therapy, and transplantation of olfactory epithelium-an overview

Olfactory disorders may be temporary or permanent and can have various causes. Currently, many COVID-19 patients report a reduced or complete loss of olfactory function. A wide range of treatment options have been investigated in the past, such as olfactory training, acupuncture, medical therapy, transcranial magnetic stimulation, or surgical excision of olfactory epithelium, e.g., in severe qualitative smell disorders. The development of a bioelectric nose, e.g., in connection with direct electrical stimulation or transplantation of olfactory epithelium or stem cells, represent treatment options of the future. The basis of these developments and the state of knowledge is discussed in the following work.

The origin of pleasant sensations: Insight from direct electrical brain stimulation

Research into the neuroanatomical basis of emotions has resulted in a plethora of studies over the last twenty years. However, studies about positive emotions and pleasant sensations remain rare and their anatomical-functional bases are less understood than that of negative emotions. Pleasant sensations can be evoked by electrical brain stimulations (EBS) during stereotactic electroencephalography (SEEG) performed for pre-surgical exploration in patients with drug-resistant epilepsy. We conducted a retrospective analysis of 10 106 EBS performed in 329 patients implanted with SEEG in our epileptology department. We found that 13 EBS in 9 different patients evoked pleasant sensations (.60% of all responses). By contrast we collected 111 emotional responses of negative valence (i.e., 5.13% of all responses). EBS evoking pleasant sensations were applied at 50 Hz with an average intensity of 1.4 ± .55 mA (range .5-2 mA). Pleasant sensations were reported by nine patients of which three patients presented responses to several EBS. We found a male predominance among the patients reporting pleasant sensations and a prominent role of the right cerebral hemisphere. Results show the preponderant role of the dorsal anterior insula and amygdala in the occurrence of pleasant sensations.

Olfactory Function and Olfactory Disorders

The sense of smell is important. This became especially clear to patients with infection-related olfactory loss during the SARS-CoV-2 pandemic. We react, for example, to the body odors of other humans. The sense of smell warns us of danger, and it allows us to perceive flavors when eating and drinking. In essence, this means quality of life. Therefore, anosmia must be taken seriously. Although olfactory receptor neurons are characterized by regenerative capacity, anosmia is relatively common with about 5 % of anosmic people in the general population. Olfactory disorders are classified according to their causes (e. g., infections of the upper respiratory tract, traumatic brain injury, chronic rhinosinusitis, age) with the resulting different therapeutic options and prognoses. Thorough history taking is therefore important. A wide variety of tools are available for diagnosis, ranging from short screening tests and detailed multidimensional test procedures to electrophysiological and imaging methods. Thus, quantitative olfactory disorders are easily assessable and traceable. For qualitative olfactory disorders such as parosmia, however, no objectifying diagnostic procedures are currently available. Therapeutic options for olfactory disorders are limited. Nevertheless, there are effective options consisting of olfactory training as well as various additive drug therapies. The consultation and the competent discussion with the patients are of major importance.

Central control of cardiac activity as assessed by intra-cerebral recordings and stimulations

Some of the most important integrative control centers for the autonomic nervous system are located in the brainstem and the hypothalamus. However, growing recent neuroimaging evidence support that a set of cortical regions, named the central autonomic network (CAN), is involved in autonomic control and seems to play a major role in continuous autonomic cardiac adjustments to high-level emotional, cognitive or sensorimotor cortical activities. Intracranial explorations during stereo-electroencephalography (SEEG) offer a unique opportunity to address the question of the brain regions involved in heart-brain interaction, by studying: (i) direct cardiac effects produced by the electrical stimulation of specific brain areas; (ii) epileptic seizures inducing cardiac modifications; (iii) cortical regions involved in cardiac interoception and source of cardiac evoked potentials. In this review, we detail the available data assessing cardiac central autonomic regulation using SEEG, address the strengths and also the limitations of this technique in this context, and discuss perspectives. The main cortical regions that emerge from SEEG studies as being involved in cardiac autonomic control are the insula and regions belonging to the limbic system: the amygdala, the hippocampus, and the anterior and mid-cingulate. Although many questions remain, SEEG studies have already demonstrated afferent and efferent interactions between the CAN and the heart. Future studies in SEEG should integrate these afferent and efferent dimensions as well as their interaction with other cortical networks to better understand the functional heart-brain interaction.

Insula in epilepsy - "untying the gordian knot": A systematic review

PURPOSE

Despite significant advances in epileptology, there are still many uncertainties about the role of the insula in epilepsy. Until recently, most insular onset seizures were wrongly attributed to the temporal lobe. Further, there are no standardised approaches to the diagnosis and treatment of insular onset seizures. This systematic review gathers the available information about insular epilepsy and synthesizes current knowledge as a basis for future research.

METHOD

Adhering to the PRISMA guidelines, studies were meticulously extracted from the PubMed database. The empirical data pertaining to the semiology of insular seizures, insular networks in epilepsy, techniques of mapping the insula, and the surgical intricacies of non-lesional insular epilepsy were reviewed from published studies. The corpus of information available was then subjected to a process of concise summarization and astute synthesis.

RESULTS

Out of 235 studies identified for full-text review, 86 studies were included in the systematic review. The insula emerges as a brain region with a number of functional subdivisions. The semiology of insular seizures is diverse and depends on the involvement of particular subdivisions. The semiological heterogeneity of insular seizures is explained by the extensive connectivity of the insula and its subdivisions with all four lobes of the brain, deep grey matter structures, and remote brainstem areas. The mainstay of the diagnosis of seizure onset in the insula is stereoelectroencephalography (SEEG). The surgical resection of the insular epileptogenic zone (when possible) is the most effective treatment. Open surgery on the insula is challenging but magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) also holds promise.

CONCLUSION

The physiological and functional roles of the insula in epilepsy have remained obfuscated. The dearth of precisely defined diagnostic and therapeutic protocols acts as an impediment to scientific advancement. This review could potentially facilitate forthcoming research endeavours by establishing a foundational framework for uniform data collection protocols, thereby enhancing the feasibility of comparing findings across future studies and promoting progress in this domain.

Responses of Chemosensory Perception to Stimulation of the Human Brain

OBJECTIVE

Significant advances have been made in our understanding of the neural substrates of human chemosensory processing, involving the piriform cortex, insula, and orbitofrontal cortex. However, the important and challenging issues are to localize the brain regions with high anatomic precision that can causally produce chemosensory perception and further delineate the topography of different classifications of chemosensory perception.

METHODS

We quantitatively measured subjective responses of chemosensory perception to intracranial electrical stimulation over the brain in neurosurgical patients (n = 302) with medically refractory epilepsy.

RESULTS

The chemosensory perceptions including olfaction, gustation, and chemesthesis were elicited in 21 of 302 patients (7%). Chemosensory responses were evoked in 53 (0.2%) of 21,661 stimulated sites. The highest response rate (1.8%) was in the insula (37/2,051 stimulated sites from 15/163 patients). The chemosensory perception emerged predominantly during stimulation of the insula along the central sulcus axis. Notably, there existed a distinct pattern that the anteroventral insula predominately represented orthonasal olfaction, whereas different chemosensory modalities converged in the mid-dorsal insula.

INTERPRETATION

This study provided a detailed characterization of chemosensory perception across the brain, especially in the insula. These results suggest that the cortex along the banks of the central sulcus of the insula may play a role in producing the supramodal sensation of flavor. It also indicates that dysfunction of the central insula should be considered during the evaluation of chemosensory-related epileptic seizures. ANN NEUROL 2023;93:175-183.

Patterns of Gray and White Matter Volume Alterations in Patients With Post-Traumatic Anosmia: A Voxel-Based Morphometry Study

Objective

Traumatic brain injury is one of the major causes of human olfactory dysfunction and leads to brain structure alterations, mainly in the cortical olfactory regions. Our study aimed to investigate volume changes in the gray matter (GM) and white matter (WM) in patients with post-traumatic anosmia and then to explore the relationship between GM volume and olfactory function.

Methods

Ethics committee approved prospective studies which included 22 patients with post-traumatic anosmia and 18 age- and gender-matched healthy volunteers. Olfactory function was assessed using the Sniffin' Sticks. High-resolution 3-dimensional T1 MRIs of the participants were acquired on a 3T scanner and the data were collected for voxel-based morphometry (VBM) analysis. Furthermore, the GM and WM volumes of the whole brain regions were compared and correlated with olfactory function.

Results

The analysis revealed significant GM volume reduction in the orbitofrontal cortex (OFC), gyrus rectus (GR), olfactory cortex, insula, parahippocampal, temporal pole, and cerebellum (all P &lt; 0.001) in patients. Besides, WM volume loss was also found in the OFC, GR, and insula (all P &lt; 0.001) in patients. All WM atrophy areas were connected to areas of GM volume loss spatially. Correlation analysis showed the olfactory scores were significantly positively correlated with the GM volume of the occipital cortex (P &lt; 0.001, and PFWE &lt; 0.05), while no significant correlation was found between the Sniffin' Sticks test scores and the WM volume in patients.

Conclusion

The reduction of GM and WM volume in olfactory-related regions was responsible for olfactory dysfunction in post-traumatic patients. The occipital cortex may play a compensation mechanism to maintain the residual olfactory function. To our knowledge, we report here for the first time on white matter volume alterations specifically in post-traumatic patients with anosmia.

Seizure semiology: ILAE glossary of terms and their significance

This educational topical review and Task Force report aims to address learning objectives of the International League Against Epilepsy (ILAE) curriculum. We sought to extract detailed features involving semiology from video recordings and interpret semiological signs and symptoms that reflect the likely localization for focal seizures in patients with epilepsy. This glossary was developed by a working group of the ILAE Commission on Diagnostic Methods incorporating the EEG Task Force. This paper identifies commonly used terms to describe seizure semiology, provides definitions, signs and symptoms, and summarizes their clinical value in localizing and lateralizing focal seizures based on consensus in the published literature. Video-EEG examples are included to illustrate important features of semiology in patients with epilepsy.

Brain Structure as a Correlate of Odor Identification and Cognition in Type 2 Diabetes

Background: It has been reported that type 2 diabetes (T2DM) is associated with olfactory identification (OI) impairments and cognitive decline. However, the relationship between OI impairments and cognitive decline is largely unknown in T2DM patients.

Methods: Sixty-eight T2DM patients and 68 healthy controls underwent 3D-T1 MRI scans, olfactory and cognitive assessments. The cortical thickness of olfaction-related brain regions, olfactory and cognitive scores were compared between groups. Correlation analyses were carried out among cognition, olfaction, and cortical thickness of olfaction-related brain regions.

Results: First, the cognitive and olfactory test scores of T2DM patients were lower than healthy subjects. Second, higher olfactory scores were associated with increased cortical thickness in the left parahippocampal gyrus and bilateral insula in T2DM. Third, higher olfactory scores were associated with higher cognitive performance in T2DM. Fourth, some cognitive performances were related to cortical thickness in the left parahippocampal gyrus and left insula in T2DM.

Conclusion: These findings indicated that olfactory dysfunction may be useful for future applications that attempt to predict cognitive decline or develop tailored therapies in T2DM patients.

Knowledge Atlas of Insular Epilepsy: A Bibliometric Analysis

OBJECTIVE

In order to determine research hotspots and prospective directions, this work used VOSviewer and CiteSpace to assess the current state of insular epilepsy research.

METHODS

We looked for pertinent research about insular epilepsy published between the first of January 2000 and the thirtieth of April 2022 in the Web of Science Core Collection (WoSCC) database. CiteSpace and VOSviewer were used to build a knowledge atlas by analyzing authors, institutions, countries, keywords with citation bursts, keyword clustering, keyword co-occurrence, publishing journals, reference co-citation patterns, and other factors.

RESULTS

A total of 305 publications on insular epilepsy were found. Nguyen DK had the most articles published (37), whereas Mauguière F and Isnard J had the highest average number of citations/publications (39.37 and 38.09, respectively). The leading countries and institutions in this field were the United States (82 papers) and Université de Montréal (40 papers). Authors, countries, and institutions appear to be actively collaborating. Hot topics and research frontiers included surgical treatment, functional network connectivity, and the application of neuroimaging methods to study insular epilepsy.

CONCLUSION

In summary, the most influential articles, authors, journals, organizations, and countries on the subject of insular epilepsy were determined by this analysis. This study investigated the area of insular epilepsy research and forecasted upcoming trends using co-occurrence and evolution methods.

The Insula: A Stimulating Island of the Brain

Direct cortical stimulation (DCS) in epilepsy surgery patients has a long history of functional brain mapping and seizure triggering. Here, we review its findings when applied to the insula in order to map the insular functions, evaluate its local and distant connections, and trigger seizures. Clinical responses to insular DCS are frequent and diverse, showing a partial segregation with spatial overlap, including a posterior somatosensory, auditory, and vestibular part, a central olfactory-gustatory region, and an anterior visceral and cognitive-emotional portion. The study of cortico-cortical evoked potentials (CCEPs) has shown that the anterior (resp. posterior) insula has a higher connectivity rate with itself than with the posterior (resp. anterior) insula, and that both the anterior and posterior insula are closely connected, notably between the homologous insular subdivisions. All insular gyri show extensive and complex ipsilateral and contralateral extra-insular connections, more anteriorly for the anterior insula and more posteriorly for the posterior insula. As a rule, CCEPs propagate first and with a higher probability around the insular DCS site, then to the homologous region, and later to more distal regions with fast cortico-cortical axonal conduction delays. Seizures elicited by insular DCS have rarely been specifically studied, but their rate does not seem to differ from those of other DCS studies. They are mainly provoked from the insular seizure onset zone but can also be triggered by stimulating intra- and extra-insular early propagation zones. Overall, in line with the neuroimaging studies, insular DCS studies converge on the view that the insula is a multimodal functional hub with a fast propagation of information, whose organization helps understand where insular seizures start and how they propagate.

Cellular activity in insular cortex across seconds to hours: Sensations and predictions of bodily states

Our wellness relies on continuous interactions between our brain and body: different organs relay their current state to the brain and are regulated, in turn, by descending visceromotor commands from our brain and by actions such as eating, drinking, thermotaxis, and predator escape. Human neuroimaging and theoretical studies suggest a key role for predictive processing by insular cortex in guiding these efforts to maintain bodily homeostasis. Here, we review recent studies recording and manipulating cellular activity in rodent insular cortex at timescales from seconds to hours. We argue that consideration of these findings in the context of predictive processing of future bodily states may reconcile several apparent discrepancies and offer a unifying, heuristic model for guiding future work.

Clinical considerations on a right operculo-insular cavernous angioma: an illustrative case

The insular cortex is considered one of the most complex regions of the brain, defined as the "hub" of somatosensory areas. Here, we examine the case of a surgically treated haemorrhagic cavernoma involving the middle and posterior insular cortex, presenting both sensory, gustative and speech symptoms. By reviewing the recent findings in humans' and primates' basic research, we illustrated clinical and radiological correlations of the reported case, confirming insular role in sensitive and gustatory functions.

Evoking highly focal percepts in the fingertips through targeted stimulation of sulcal regions of the brain for sensory restoration

Background:

Paralysis and neuropathy, affecting millions of people worldwide, can be accompanied by significant loss of somatosensation. With tactile sensation being central to achieving dexterous movement, brain-computer interface (BCI) researchers have used intracortical and cortical surface electrical stimulation to restore somatotopically-relevant sensation to the hand. However, these approaches are restricted to stimulating the gyral areas of the brain. Since representation of distal regions of the hand extends into the sulcal regions of human primary somatosensory cortex (S1), it has been challenging to evoke sensory percepts localized to the fingertips.

Objective/hypothesis:

Targeted stimulation of sulcal regions of S1, using stereoelectroencephalography (SEEG) depth electrodes, can evoke focal sensory percepts in the fingertips.

Methods:

Two participants with intractable epilepsy received cortical stimulation both at the gyri via high-density electrocorticography (HD-ECoG) grids and in the sulci via SEEG depth electrode leads. We characterized the evoked sensory percepts localized to the hand.

Results:

We show that highly focal percepts can be evoked in the fingertips of the hand through sulcal stimulation. fMRI, myelin content, and cortical thickness maps from the Human Connectome Project elucidated specific cortical areas and sub-regions within S1 that evoked these focal percepts. Within-participant comparisons showed that percepts evoked by sulcal stimulation via SEEG electrodes were significantly more focal (80% less area; p = 0.02) and localized to the fingertips more often, than by gyral stimulation via HD-ECoG electrodes. Finally, sulcal locations with consistent modulation of high-frequency neural activity during mechanical tactile stimulation of the fingertips showed the same somatotopic correspondence as cortical stimulation.

Conclusions:

Our findings indicate minimally invasive sulcal stimulation via SEEG electrodes could be a clinically viable approach to restoring sensation.

Decreased self-reported appetite following insular cortex resection in patients with epilepsy

Entrenched deep within the Sylvian fissure, the insula has long been considered one of the least understood regions of the human brain, in part due to its restricted accessibility. However, recent evidence suggests that the insula plays a key role in gustation, interoception, cognitive and emotional processes, and likely integrates these different functions to contribute to the homeostatic control of food intake. In the past decade, our team has identified the insula as a potential site of epileptogenicity, which can be successfully treated by microsurgical resection. While most surgeries are successful in controlling insular epileptic seizures and lead to few postoperative deficits, the subtle changes that may occur in food-related experiences are still unknown. Using a self-report questionnaire, the present study sought to fill this gap by assessing changes in appetite in patients who underwent unilateral partial or complete insular resections (n = 17) as part of their epilepsy surgery. We compared them to a group of patients who underwent temporal lobe epilepsy surgery (n = 22) as a lesion-control group. A majority (59%) of the insular patients reported an alteration in appetite, with most of these changes being characterized by a persistent reduction. Such changes were rarely reported following temporal lobectomy (14%). While they significantly differed in terms of appetite changes, both groups were similar when examining post-surgical changes in weight, diet, exercise and eating habits. Insular patients with altered appetite also showed behavioral signs of dysfunctional interoceptive and gustatory functions, corroborating the idea that these systems play a role in the regulation of feeding behaviours. This research pushes our understanding of the mechanisms underlying food intake and could lead to avenues for the treatment of eating disorders.

Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

INTRODUCTION

To date, clinical trials of deep brain stimulation (DBS) for refractory chronic pain have yielded unsatisfying results. Recent evidence suggests that the posterior insula may represent a promising DBS target for this indication.

METHODS

We present a narrative review highlighting the theoretical basis of posterior insula DBS in patients with chronic pain.

RESULTS

Neuroanatomical studies identified the posterior insula as an important cortical relay center for pain and interoception. Intracranial neuronal recordings showed that the earliest response to painful laser stimulation occurs in the posterior insula. The posterior insula is one of the only regions in the brain whose low-frequency electrical stimulation can elicit painful sensations. Most chronic pain syndromes, such as fibromyalgia, had abnormal functional connectivity of the posterior insula on functional imaging. Finally, preliminary results indicated that high-frequency electrical stimulation of the posterior insula can acutely increase pain thresholds.

CONCLUSION

In light of the converging evidence from neuroanatomical, brain lesion, neuroimaging, and intracranial recording and stimulation as well as non-invasive stimulation studies, it appears that the insula is a critical hub for central integration and processing of painful stimuli, whose high-frequency electrical stimulation has the potential to relieve patients from the sensory and affective burden of chronic pain.

[Future therapeutic strategies for olfactory disorders: electrical stimulation, stem cell therapy, and transplantation of olfactory epithelium-an overview]

Passagere oder permanente Riechstörungen können verschiedene Ursachen haben. Ganz aktuell berichtet eine Vielzahl von Patienten im Rahmen von COVID-19-Infektionen über ein fehlendes oder vermindertes Riechvermögen. In der Vergangenheit wurden vielfältige Therapieoptionen untersucht, diese variieren vom Riechtraining über Akupunktur und medikamentöse Therapien bis hin zur transkraniellen Magnetstimulation oder, z. B. bei ausgeprägten qualitativen Riechstörungen, der chirurgischen Resektion der Riechschleimhaut. Die Entwicklung einer bioelektrischen Nase, z. B. in Verbindung mit direkter elektrischer Stimulation des Bulbus olfactorius, oder die Transplantation von Riechschleimhaut oder von Stammzellen stellen Behandlungsmöglichkeiten der Zukunft dar. Die Grundlagen für diese Entwicklungen sowie der Stand des Wissens werden in der vorliegenden Arbeit erläutert.

Insula and Olfaction: A Literature Review and Case Report

(1) Background: It is well established that the insula is involved in olfaction, though its specific role in olfactory processing remains uncertain. In this paper, we first review the current literature on the insula and olfaction. Then, we describe the case of a 56-year-old man with a left insular cavernoma that caused olfactory disturbances. (2) Results: Structural neuroimaging studies suggest that insular gray matter volume is related to olfactory function, and functional neuroimaging shows that various types of stimuli lead to either lateralized or bilateral insular activations. Studies using electro-cortical stimulation reveal a specific region of the insular cortex, around the central insular sulcus, that could be related to unpleasant odor processing. Previous cases of insular lesions leading to olfactory disturbances suggest that left-sided insular lesions may more frequently lead to olfactory changes. In our patient with a left insular cavernoma, odors that were previously perceived as pleasant started smelling unpleasant and were hard to distinguish. Despite these subjective complaints, olfactory function assessed with the Sniffin’ Sticks test was normal. (3) Conclusions: Current tests may not be sensitive to all types of olfactory impairments associated with insular damage, and further studies should be conducted to develop olfactory tests assessing the hedonic appreciation of odors.

Sensory profile alterations in patients with insular epilepsy surgery: Preliminary findings

The insular cortex is now well-established as a potential site of epileptogenesis in patients with drug-resistant epilepsy, and its resection has been associated with good outcomes in terms of seizure control. However, given the role of the insula in sensory processing and in visceral information integration, it remains unclear whether insular cortex epilepsy and its surgery are associated with disturbances in sensory information processing and visceral sensation processes as experienced in daily life. In the present study, we examined such sensory disturbances in a group of patients (n = 17) who underwent epilepsy surgery involving a resection of the insula and compared them to a lesion-control group of patients with temporal epilepsy surgery (n = 22) and a healthy control group (n = 29) matched for age, gender, and education. Participants were assessed on the self-report "Adolescent/Adult Sensory Profile" questionnaire at least four months after surgery. Our series of one-way analyses of variance (ANOVAs) revealed that insular and temporal resections in patients with drug-refractory epilepsy were associated with a low "sensation seeking" behavior reflecting a lack of engagement with sensory inputs from the environment. Furthermore, insular resections were associated with impairments in the "active behavioral responses" for the gustatory/olfactory modalities. These preliminary findings suggest that insular resections may be associated with mild to moderate alterations in sensory processing.

Mindfulness, Interoception, and Olfaction: A Network Approach

The fine-tuned interplay between the brain and the body underlies the adaptive ability to respond appropriately in the changing environment. Mindfulness Disposition (MD) has been associated with efficient emotional functioning because of a better ability to feel engaged by information from the body and to notice subtle changes. This interoceptive ability is considered to shape the ability to respond to external stimuli, especially olfaction. However, few studies have evaluated the relationships between interoception and exteroception according to MD. We conducted an exploratory study among 76 healthy subjects for first investigating whether MD is associated with better exteroception and second for describing the causal interactions network between mindfulness, interoception, emotion, and subjective and objective olfaction assessments. Results found that a high level of MD defined by clustering exhibited best scores in positive emotions, interoception, and extra sensors’ acuity. The causal network approach showed that the interactions between the interoception subscales differed according to the MD profiles. Moreover, interoception awareness is strongly connected with both the MD and the hedonic value of odors. Then, differences according to MD might provide arguments for a more mindful attention style toward interoceptive cues in relation to available exteroceptive information. This interaction might underlie positive health.

Optimized Electrode Placements for Non-invasive Electrical Stimulation of the Olfactory Bulb and Olfactory Mucosa

The olfactory system is known to be dysfunctional in the early stages of Parkinson's disease (PD) and Alzheimer's disease (AD). It is also shown that intact olfactory function can be a key role player for regaining consciousness after brain injuries. Modulation of the olfactory regions has been attempted successfully with electrical stimulation over the years, either directly (transethmoidally, intraoperatively, internasally, etc.) or indirectly through the vagus nerve. We sought to develop a means of delivering optimized electrical stimulation to the olfactory region in a non-invasive fashion and in a way that is simpler, easier, and less cumbersome. The ultimate goal was to develop a system that would allow easier testing in future clinical trials presenting an opportunity to fully develop this potential treatment option. We devised six potential electrode placements leveraging commonly accepted facts of electrical stimulation, easier access through relatively higher conductive pathways into the brain, and practicality. Using an ultra-high-resolution finite element model, we screened each one of these montages for their ability to target the olfactory regions primarily and thereafter for select sub-cortical regions implicated in the pathogenesis of PD and AD. Modeling results indicate that some placements do result in inducing meaningful electric field magnitudes in the regions of interest. A practical headgear concept is proposed to realize the most ideal configuration. Our results pave the way for developing the first non-invasive electrical stimulation wearable system for targeting the olfactory regions which can help to alleviate the symptoms or suppress the progression of these neurological disorders.

Two Neural Networks for Laughter: A Tractography Study

Laughter is a complex motor behavior occurring in both emotional and nonemotional contexts. Here, we investigated whether the different functions of laughter are mediated by distinct networks and, if this is the case, which are the white matter tracts sustaining them. We performed a multifiber tractography investigation placing seeds in regions involved in laughter production, as identified by previous intracerebral electrical stimulation studies in humans: the pregenual anterior cingulate (pACC), ventral temporal pole (TPv), frontal operculum (FO), presupplementary motor cortex, and ventral striatum/nucleus accumbens (VS/NAcc). The primary motor cortex (M1) and two subcortical territories were also studied to trace the descending projections. Results provided evidence for the existence of two relatively distinct networks. A first network, including pACC, TPv, and VS/NAcc, is interconnected through the anterior cingulate bundle, the accumbofrontal tract, and the uncinate fasciculus, reaching the brainstem throughout the mamillo-tegmental tract. This network is likely involved in the production of emotional laughter. A second network, anchored to FO and M1, projects to the brainstem motor nuclei through the internal capsule. It is most likely the neural basis of nonemotional and conversational laughter. The two networks interact throughout the pre-SMA that is connected to both pACC and FO.

Altered grey matter volume in 'super smellers'

‘Super smellers‘ are those individuals who show a heightened sense of smell. Data on the structural neuroanatomy of this phenomenon are still missing. A voxel-based morphometry study was conducted in order to compare gray matter volume (GMV) in specific brain regions of the olfactory network (piriform/entorhinal cortex, orbitofrontal cortex, insula, hippocampus) between 25 male ‘super smellers’ and 20 normosmic men. Participants were assigned to these groups based on their scores on a standardized olfactory performance test. Relative to normosmic men, ‘super smellers’ showed increased GMV in the anterior insula and in the hippocampus (dentate gyrus). These regions are crucial for the integration of olfactory information as well as odor learning and odor memory. Moreover, positive correlations between hippocampal volume and olfactory performance were detected in both groups. Future research should elaborate on how much of the observed neuroanatomical pattern of ‘super smellers’ is genetic and how much of it reflects experienced-based GMV increase.

Stimulation Mapping Using Stereoelectroencephalography: Current and Future Directions

Electrical stimulation mapping (ESM) using stereoelectroencephalography (SEEG) is an essential component in the workup of surgical epilepsy. Since the initial application of ESM in the mid-1960s, it remains unparalleled in defining eloquent brain areas and delimiting seizure foci for the purposes of surgical planning. Here, we briefly review the current state of SEEG stimulation, with a focus on the techniques used for identifying the epileptogenic zone and eloquent cortex. We also summarize clinical data on the efficacy of SEEG stimulation in surgical outcomes and functional mapping. Finally, we briefly highlight future applications of SEEG ESM, including novel functional mapping approaches, identifying rare seizure semiologies, neurophysiologic investigations for understanding cognitive function, and its role in SEEG-guided radiofrequency thermal coagulation.

Insular Cell Integrity Markers Linked to Weight Concern in Anorexia Nervosa-An MR-Spectroscopy Study

Objective: An insular involvement in the pathogenesis of anorexia nervosa (AN) has been suggested in many structural and functional neuroimaging studies. This magnetic resonance spectroscopy (MRS) study is the first to investigate metabolic signals in the anterior insular cortex in patients with AN and recovered individuals (REC). Method: The MR spectra of 32 adult women with AN, 21 REC subjects and 33 healthy controls (HC) were quantified for absolute N-acetylaspartate (NAA), glutamate + glutamine (Glx), total choline, myo-inositol, creatine concentrations (mM/L). After adjusting the metabolite concentrations for age and partial gray/white matter volume, group differences were tested using one-way multivariate analyses of variance (MANOVA). Post-hoc analyses of variance were applied to identify those metabolites that showed significant group effects. Correlations were tested for associations with psychometric measures (eating disorder examination), duration of illness, and body mass index. Results: The MANOVA exhibited a significant group effect. The NAA signal was reduced in the AN group compared to the HC group. The REC and the HC groups did not differ in metabolite concentrations. In the AN group, lower NAA and Glx signals were related to increased weight concern. Discussion: We interpret the decreased NAA availability in the anterior insula as a signal of impaired neuronal integrity or density. The association of weight concern, which is a core feature of AN, with decreased NAA and Glx indicates that disturbances of glutamatergic neurotransmission might be related to core psychopathology in AN. The absence of significant metabolic differences between the REC and HC subjects suggests that metabolic alterations in AN represent a state rather than a trait phenomenon.

Interoceptive accuracy and its impact on neuronal responses to olfactory stimulation in the insular cortex

The insular cortex plays a key role in the integration of multimodal information and in interoceptive and exteroceptive processing. For instance, neurons in the central dorsal insula that are active during interoceptive tasks, also show an adaptation to gustatory stimulation. We tested the link between interoception and exteroception for the olfactory system (i.e., the second domain of chemosensation). In a sample of 31 participants, olfactory function was assessed in a two dimensional approach while the Heartbeat Perception Task served as a measurement for cardiac interoceptive accuracy. Subsequent fMRI sessions were performed on a 3‐Tesla MR scanner containing 12–15 olfactory stimulation trials with a mildly pleasant food‐related odor (coffee). Persons scoring high in the cardiac interoceptive accuracy task presented stronger smelling abilities as well as enhanced BOLD responses following olfactory stimulation. The olfactory stimulation triggered enhanced insular activation patterns in the central dorsal insular cortex. Consistent with prior findings on the coherence of gustatory and interoceptive processing in the central dorsal insula, these results base the insula as a common region for the integration of interoception and exteroception. We propose an explanatory model of how exteroception triggers the integration of intero‐ and exteroceptive sensations in the central dorsal insular cortex.

Temporolimbic cortical volume is associated with semantic odor memory performance in aging

Olfactory function, and specifically semantic olfactory memory (i.e., odor identification), has frequently been shown to predict cognitive functioning across multiple domains in old age. This observation suggests that olfactory function can serve as a marker for the integrity of temporolimbic cortical networks, but a clear delineation of this association is still missing. To address this issue, the present study employed voxel-based morphometry in a region of interest-based design to determine the extent to which gray matter volumes of core olfactory and memory areas are associated with olfactory memory performance in an aging population free from neurodegenerative disease. We further aimed to determine potential overlap in structural anatomical correlates, and differences in association strength, for semantic and episodic olfactory memory. Structural magnetic resonance imaging (MRI), episodic and semantic odor memory and episodic and semantic verbal memory data were collected in 422 participants from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), all aged ​≥ ​60 years. Controlling for age and education, semantic, but not episodic, olfactory memory was positively related to gray matter volume in a cluster extending from the anterior hippocampus and amygdala into the posterior piriform cortex. The observed associations remained even when verbal memory performance was controlled for, supporting a link between the olfactory memory domain and cortical volume over and above more generalized memory abilities. As such, our data provide evidence for distinct functional-structural associations for semantic odor memory, supporting the idea of temporolimbic integrity as a neurobiological substrate linking olfactory function to cognitive health in old age.

Cranial Nerve Stimulation for Olfaction (Cranial Nerve 1)

Like sensory maps in other systems, the sense of smell has an organizational structure based on converging projections of olfactory receptor neurons containing unique odorant receptors onto the olfactory bulb in synaptic aggregations termed glomeruli. This organizational structure provides the potential for electrical stimulation and restoration of smell. Prior animal and human studies support the feasibility of an olfactory stimulation device, encouraging ongoing work in development of olfactory implants.

Influence of olfactory dysfunction on the perception of food

PURPOSE

Eating-related problems are among the most frequent issues in olfactory impairment, causing a noticeable loss of quality of life for some of the affected persons. To what extent olfactory dysfunction impacts on the sensory perception of food is less explored. The aim of the present study was to examine the impact of olfactory dysfunction on the perception of food aromas, as well as the perception of the "basic tastes" salty, sour, sweet, and bitter.

METHODS

Eighty-nine participants were recruited for the prospective study. Group 1 consisted of thoroughly examined patients with olfactory dysfunction (n = 48, mean age = 60.0 years), group 2 consisted of people with normal olfactory function (n = 41, mean age = 50.4 years). First, olfactory and gustatory functions were assessed for all participants with the help of the "Sniffin'Sticks" battery and the "taste strips" test. Second, food odors were rated for their pleasantness, intensity, familiarity and desirability. Last, real food items were tasted orally and the intensity for basic taste qualities (sweet, bitter, salty, and sour) and pleasantness was rated. In addition, salivation was measured following exposure to the food odors.

RESULTS

In comparison to controls, patients rated orthonasal food odors as less pleasant, intense, familiar, and less appetizing. "Taste strip" scores were significantly lower in patients (M = 9.56, SD = 2.76) as compared to controls (M = 10.88, SD = 1.89). In addition, ratings of food liking for chocolate and peanut were lower in patients compared to controls (chocolate: patients-M = 6.85, SD = 2.09, controls-M = 7.90, SD = 1.53; peanut: patients-M = 4.88, SD = 2.20, controls-M = 6.80, SD = 2.33). No significant differences were found regarding the comparison of the salivary flow rate in controls (M = 0.52 g/min, SD = 0.19) and patients (M = 0.50 SD = 0.17).

CONCLUSIONS

Changes in the perception of odors may change the perception of food with specific effects on food liking. Olfactory dysfunction affects gustatory function, indicating the central-nervous interaction between taste and smell. Still, olfactory dysfunction did not appear to affect patients' salivary flow.

Olfactory and Gustatory Dysfunction in Patients With Autoimmune Encephalitis

Objective: To test the hypothesis that olfactory (OF) and gustatory function (GF) is disturbed in patients with autoimmune encephalitides (AE). Methods: The orthonasal OF was tested in 32 patients with AE and 32 age- and sex-matched healthy controls (HC) with the standardized Threshold Discrimination Identification (TDI) score. This validated olfactory testing method yields individual scores for olfactory threshold (T), odor discrimination (D), and identification (I), along with a composite TDI score. The GF was determined by the Taste Strip Test (TST). Results: Overall, 24/32 (75%) of patients with AE, but none of 32 HC (p < 0.001) had olfactory dysfunction in TDI testing. The results of the threshold, discrimination and identification subtests were significantly reduced in patients with AE compared to HC (all p < 0.001). Assessed by TST, 5/19 (26.3%) of patients with AE, but none of 19 HC presented a significant limitation in GF (p < 0.001). The TDI score was correlated with the subjective estimation of the olfactory capacity on a visual analog scale (VAS; r_s = 0.475, p = 0.008). Neither age, sex, modified Rankin Scale nor disease duration were associated with the composite TDI score. Conclusions: This is the first study investigating OF and GF in AE patients. According to unblinded assessment, patients with AE have a reduced olfactory and gustatory capacity compared to HC, suggesting that olfactory and gustatory dysfunction are hitherto unrecognized symptoms in AE. Further studies with larger number of AE patients would be of interest to verify our results.

Recognizing Taste: Coding Patterns Along the Neural Axis in Mammals

The gustatory system encodes information about chemical identity, nutritional value, and concentration of sensory stimuli before transmitting the signal from taste buds to central neurons that process and transform the signal. Deciphering the coding logic for taste quality requires examining responses at each level along the neural axis-from peripheral sensory organs to gustatory cortex. From the earliest single-fiber recordings, it was clear that some afferent neurons respond uniquely and others to stimuli of multiple qualities. There is frequently a "best stimulus" for a given neuron, leading to the suggestion that taste exhibits "labeled line coding." In the extreme, a strict "labeled line" requires neurons and pathways dedicated to single qualities (e.g., sweet, bitter, etc.). At the other end of the spectrum, "across-fiber," "combinatorial," or "ensemble" coding requires minimal specific information to be imparted by a single neuron. Instead, taste quality information is encoded by simultaneous activity in ensembles of afferent fibers. Further, "temporal coding" models have proposed that certain features of taste quality may be embedded in the cadence of impulse activity. Taste receptor proteins are often expressed in nonoverlapping sets of cells in taste buds apparently supporting "labeled lines." Yet, taste buds include both narrowly and broadly tuned cells. As gustatory signals proceed to the hindbrain and on to higher centers, coding becomes more distributed and temporal patterns of activity become important. Here, we present the conundrum of taste coding in the light of current electrophysiological and imaging techniques at several levels of the gustatory processing pathway.

Dysfunction of the to in Anorexia and Bulimia Nervosa: A fMRI

Brain reward dysfunction in eating disorders has been widely reported. However, whether the neural correlates of hedonic and motivational experiences related to food cues are differentially affected in anorexia nervosa of restrictive type (ANr), bulimia nervosa (BN), and healthy control (HC) participants remains unknown. Here, 39 women (14 ANr, 13 BN, and 12 HC) underwent fMRI while smelling food or non-food odors in hunger and satiety states during liking and wanting tasks. ANr and BN patients reported less desire to eat odor-cued food and odor-cued high energy-density food (EDF), respectively. ANr patients exhibited lower ventral tegmental area (VTA) activation than BN patients to food odors when rating their desire to eat, suggesting altered incentive salience attribution to food odors. Compared with HC participants, BN patients exhibited decreased activation of the caudate nucleus to food odors in the hunger state during the wanting task. Both patient groups also showed reduced activation of the anterior ventral pallidum and insula in response to high EDF odors in the hunger state during the wanting task. These findings indicate that brain activation within the food reward-regulating circuit differentiates the three groups. ANr patients further exhibited lower activation of the precuneus than other participants, suggesting a possible role of body image distortion in ANr. Our study highlights that food odors are relevant sensory probes to gain better insight into the dysfunction of the mesolimbic and striatal circuitry involved in food reward processing in patients with EDs.

Functional mapping of the human insula: Data from electrical stimulations

Electrical stimulations of the insula performed during stereo-electro-encephalography (SEEG) reproduce the ictal symptoms observed during the development of insular seizures and are also a unique opportunity to provide a functional mapping of the insular cortex. We provide here a functional mapping of the insular cortex obtained by electrical stimulation, based on our previous work and a review of literature. The most frequent responses to insula stimulation were somatosensory sensations followed by visceral responses. Then, in decreasing order of frequency, auditory sensations, vestibular illusions, speech impairment, gustato-olfactory sensations and motor reactions were evoked. A bipolar organization could be evidenced with a posterior part assigned to somatosensory functions and notably to pain perception; and an anterior part assigned to visceral functions. Although some degree of spatial segregation could be evidenced, there was a clear spatial overlap between the representations of the different types of responses. These data provide a better understanding of physiological insular functions, insula seizures semiology and a prediction of post-surgical deficits. Insula is the only cortical region where stimulations demonstrate such a multi-modal representation, perhaps supporting its integrative functions of polymodal inputs.

How the insula speaks to the heart: Cardiac responses to insular stimulation in humans

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.

Development of the human olfactory system

This chapter focuses on the development of the human olfactory system. In this system, function does not require full neuroanatomical maturity. Thus, discrimination of odorous molecules, including a number within the mother's diet, occurs in amniotic fluid after 28-30 weeks of gestation, at which time the olfactory bulbs are identifiable by MRI. Hypoplasia/aplasia of the bulbs is documented in the third trimester and postnatally. Interestingly, olfactory axons project from the nasal epithelium to the telencephalon before formation of the olfactory bulbs and lack a peripheral ganglion, but the synaptic glomeruli of the future olfactory bulb serves this function. Histologic lamination of the olfactory bulb is present by 14 weeks, but maturation remains incomplete at term for neuronal differentiation, synaptogenesis, myelination, and persistence of the normal transitory fetal ventricular recess. Myelination occurs postnatally. Although olfaction is the only sensory system without direct thalamic projections, the olfactory bulb and anterior olfactory nucleus are, in effect, thalamic surrogates. For example, many dendro-dendritic synapses occur within the bulb between GABAergic granular neurons and periglomerular neurons. Moreover, bulbar synaptic glomeruli are analogous to peripheral ganglia of other sensory cranial nerves. The olfactory tract contains much gray as well as white matter. The olfactory epithelium and bulb both incorporate progenitor cells at all ages. Diverse malformations of the olfactory bulb can be detected by clinical examination, imaging, and neuropathology; indeed, olfactory reflexes of the neonate can be reliably tested. We recommend that such testing be routine in the neonatal neurologic examination, especially in children with brain malformations, endocrinopathies, chromosomopathies, genetic/metabolic disorders, and perinatal hypoxic/ischemic encephalopathy.

Induction of smell through transethmoid electrical stimulation of the olfactory bulb

BACKGROUND

Anosmia has an estimated prevalence of 5% of the general population. Outside of inflammatory causes, therapeutic options are limited despite research advances. Bypassing peripheral neuronal damage through central stimulation is a potential therapeutic option that has shown success in other sensory systems, most notably with hearing. We performed a pilot study to determine the feasibility of inducing smell through artificial electrical stimulation of the olfactory bulbs in humans.

METHODS

Subjects with a history of sinus surgery, including total ethmoidectomy, with intact ability to smell were enrolled. The ability to smell was confirmed with a 40-item smell identification test. Awake subjects underwent nasal endoscopy and either a monopolar or bipolar electrode was positioned at 3 areas along the lateral lamella of the cribriform plate within the ethmoid sinus cavity. A graded stimulation current of 1-20 mA at 3.17 Hz was administered while cortical evoked potential (CEP) recordings were collected. Subjective responses of perceived smell along with reports of discomfort were recorded. Subjects with artificially induced smell underwent repeat stimulation after medically induced anosmia.

RESULTS

Five subjects (age, 43-72 years) were enrolled. Three subjects reported smell perception smell with electrical stimulation. This was reproducible after inducing anosmia, but CEP recordings could not provide objective support. All subjects tolerated the study with minimal discomfort.

CONCLUSION

This is the first report of induced smell through transethmoid electrical stimulation of the olfactory bulb. These results provide a proof of concept for efforts in development of an olfactory implant system.

Fat perception in the human frontal operculum, insular and somatosensory cortex

Here, we combined magnetic resonance imaging with lesion-symptom mapping in patients with chronic brain lesions to investigate brain representations of sugar and fat perception. Patients and healthy controls rated chocolate milkshakes that only differed in sugar or fat content. As compared to controls, patients showed an impaired fat, but not sugar perception. Impairments in fat perception overlapped with the anterior insula and frontal operculum, together assumed to underpin gustatory processing. We also identified the mid-dorsal insula as well as the primary and secondary somatosensory cortex - regions previously assumed to integrate oral-sensory inputs. These findings suggest that fat perception involves a specific set of brain regions that were previously reported to underpin gustatory processing and oral-sensory integration processes.