Déjà vu in unilateral temporal-lobe epilepsy is associated with selective familiarity impairments on experimental tasks of recognition memory

Non-ictal, interictal and ictal déjà vu: a systematic review and meta-analysis

Background

Déjà vu, French for "already seen," is a phenomenon most people will experience at least once in their lifetime. Emerging evidence suggests that déjà vu occurs in healthy individuals (as "non-ictal déjà vu") and in epilepsy patients during seizures (as "ictal déjà vu") and between seizures (as "interictal déjà vu"). Although the ILAE has recognized déjà vu as a feature of epileptic seizures, it is notably absent from the ICD-11. A lack of evidence-based research may account for this omission. To our knowledge, this study represents the first systematic review and meta-analysis on déjà vu experiences. Through detailed examinations of non-ictal, interictal and ictal déjà vu, we seek to highlight possible clinical implications. Rethinking the status quo of ictal déjà vu could potentially lead to earlier interventions and improve outcomes for epilepsy patients.

Methods

This study was registered in PROSPERO (ID: CRD42023394239) on 5 February 2023. Systematic searches were conducted across four databases: EMBASE, MEDLINE, PsycINFO, and PubMed, from inception to 1 February 2023, limited to English language and human participants. Studies were included/excluded based on predefined criteria. Data was extracted according to the PICO framework and synthesized through a thematic approach. Meta-analyses were performed to estimate prevalence's of the phenomena. Study quality, heterogeneity, and publication bias were assessed.

Results

Database searching identified 1,677 records, of which 46 studies were included. Meta-analyses of prevalence showed that non-ictal déjà vu was experienced by 0.74 (95% CI [0.67, 0.79], p < 0.001) of healthy individuals, whereas interictal déjà vu was experienced by 0.62 (95% CI [0.48, 0.75], p = 0.099) and ictal déjà vu by 0.22 (95% CI [0.15, 0.32], p = 0.001) of epilepsy patients. Examinations of phenomenological (sex, age, frequency, duration, emotional valence, and dissociative symptoms) and neuroscientific (brain structures and functions) data revealed significant variations between non-ictal, interictal and ictal déjà vu on several domains.

Conclusion

This systematic review and meta-analysis do not support the notion that non-ictal, interictal and ictal déjà vu are homogenous experiences. Instead, it provides insight into ictal déjà vu as a symptom of epilepsy that should be considered included in future revisions of the ICD-11.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394239, CRD42023394239.

Towards a conflict account of déjà vu: The role of memory errors and memory expectation conflict in the experience of déjà vu

Déjà vu can be defined as conflict between a subjective evaluation of familiarity and a concurrent evaluation of novelty. Accounts of the déjà vu experience have not explicitly referred to a "conflict account of déjà vu" despite the acceptance of conflict-based definitions of déjà vu and relatively recent neuroimaging work that has implicated brain areas associated with conflict as underpinning the experience. Conflict monitoring functioning follows a similar age-related trajectory to déjà vu with a peak in young adulthood and a subsequent age-related decline. In this narrative review of the literature to date, we consider how déjà vu is defined and how this has influenced the understanding of déjà vu. We also review how déjà vu can be understood within theories of recognition memory and cognitive control. Finally, we summarise the conflict account of déjà vu and propose that this account of the experience may provide a coherent explanation as to why déjà vu experiences tend to decrease with age in the non-clinical population.

Specificity of performance validity tests in patients with confirmed epilepsy

Objective: While assessment of performance validity is essential to neuropsychological evaluations, use of performance validity tests (PVTs) in an epilepsy population has raised concerns due to factors that may result in performance fluctuations. The current study assessed whether specificity was maintained at previously suggested cutoffs in a confirmed epilepsy population on the Warrington Recognition Memory Test (WRMT) - Words and Test of Memory Malingering (TOMM). Method: Eighty-two confirmed epilepsy patients were administered the WRMT-Words and TOMM as part of a standardized neuropsychological evaluation. Frequency tables were utilized to investigate specificity rates on these two PVTs. Results: The suggested WRMT-Words Accuracy Score cutoff of ≤42 was associated with a specificity rate of 90.2%. Five out of the 8 individuals falling below the Accuracy Score cutoff scored 42, suggesting specificity could be further improved by slightly lowering the cutoff. The WRMT-Words Total Time cutoff of ≥207 seconds was associated with 95.1% specificity. A TOMM Trial 1 cutoff of <40 was associated with 93.9% specificity, while the established cutoff of <45 on Trial 2 and the Retention Trial yielded specificity rates of 98.6% and 100.0%, respectively. Conclusions: Our findings demonstrate acceptable performance on two PVTs in a select confirmed epilepsy population without a history of brain surgery, active seizures during testing, and/or low IQ, irrespective of various factors such as seizure type, seizure lateralization/localization, and language lateralization. The possible presence of interictal discharges were not controlled for in the current study, which may have contributed to reduced PVT performances.

Association of Deja Vu with Cardiovascular Diseases

Recent studies have suggested a link between déjà vu and cardiovascular diseases. While the mechanism for this association is not fully understood, one theory suggests that déjà vu may be a result of a disruption in the temporal lobe, which is also responsible for regulating blood pressure and heart rate. Another theory suggests that there may be a shared genetic factor between the two conditions, with certain individuals being predisposed to experiencing both. The APOE (Apolipoprotein E) gene, in particular, has been associated with memory processing, Alzheimer's disease, and an increased risk of cardiovascular disease. The protein encoded by this gene is involved in the metabolism of lipoproteins, including cholesterol and triglycerides, and is also involved in the development of atherosclerosis, which is a key risk factor for cardiovascular disease. Several hypotheses have been proposed to explain how the APOE4 isoform contributes to CVD, including impairing the clearance of lipoproteins, promoting inflammation, and causing endothelial dysfunction. Psychological factors such as stress may also contribute to the development of cardiovascular disease, and déjà vu may be associated with emotional arousal and stress. Further research is needed to fully understand the link between déjà vu and cardiovascular diseases and to explore potential treatment options for individuals who experience both conditions.

Modulation of GABAB receptors in the insula bidirectionally affects associative memory of epilectic rats in both spatial and non-spatial operant tasks

Background

Stimulation of gamma-aminobutyric acid (GABA) activity through GABA receptor agonists is the basic mechanism of many anticonvulsant drugs. Nevertheless, many of these GABergic drugs have adverse cognitive effects. We previously found that GABAB receptors (GABA_BRs) in the insula regulate operant associative memory in healthy rats. The present study aimed at investigating the effects of GABA_BR modulation in the insula on operant associative memory in epileptic rats, along with the underlying mechanisms.

Methods

The lithium-pilocarpine model of temporal lobe epilepsy (TLE) was established in male Sprague-Dawley rats. A 22-gauge stainless-steel guide cannula was surgically implanted into the granular insula cortex of the epileptic rats. Baclofen (125 ng/μl, 1 μl), CGP35348 (12.5 μg/μl, 1 μl), or saline (1 μl) was slowly infused through the guide cannula. The Intellicage automated behavioral testing system was used to evaluate operant associative memory of the epileptic rats, including non-spatial operant tasks (basic nosepoke learning and skilled nosepoke learning) and spatial operant tasks (chamber position learning). The expression of the GABA_BR subunits GB1 and GB2 in the insula was examined by immunofluorescence and Western blotting.

Results

The Intellicage tests demonstrated that baclofen significantly impaired basic nosepoke learning, skilled nosepoke learning and chamber position learning of the epileptic rats, while CGP35348 boosted these functions. Immunofluorescence staining revealed that GB1 and GB2 were expressed in the insula of the epileptic rats, and Western blotting analysis showed that baclofen enhanced while CGP35348 inhibited the expression of these subunits.

Conclusion

GABA_BRs in the insula bidirectionally regulate both spatial and non-spatial operant associative memory of epileptic rats. Effects of GABA_BRs on cognition should be taken into account when evaluating new possible treatments for people with epilepsy.

Are involuntary autobiographical memory and déjà vu natural products of memory retrieval?

Involuntary autobiographical memories (IAMs) and déjà vu are phenomena that occur spontaneously in daily life. IAMs are recollections of the personal past, whereas déjà vu is defined as an experience in which the person feels familiarity at the same time as knowing that the familiarity is false. We present and discuss the idea that both IAMs and déjà vu can be explained as natural phenomena resulting from memory processing and, importantly, are both based on the same memory retrieval processes. Briefly, we hypothesise that both can be described as "involuntary" or spontaneous cognitions, where IAMs deliver content and déjà vu delivers only the feeling of retrieval. We map out the similarities and differences between the two, making a theoretical and neuroscientific account for their integration into models of memory retrieval and how the autobiographical memory literature can explain these quirks of daily life and unusual but meaningful phenomena. We explain the emergence of the déjà vu phenomenon by relating it to well-known mechanisms of autobiographical memory retrieval, concluding that IAMs and déjà vu lie on a continuum.

Subjective distinguishability of seizure and non-seizure Déjà Vu: A case report, brief literature review, and research prospects

Roughly two-thirds of all people report having experienced déjà vu-the odd feeling that a current experience is both novel and a repeat or replay of a previous, unrecalled experience. Reports of an association between déjà vu and seizure aura symptomatology have accumulated for over a century, and frequent déjà vu is also now known to be associated with focal seizures, particularly those of a medial temporal lobe (MTL) origin. A longstanding question is whether seizure-related déjà vu has the same basis and is the same subjective experience as non-seizure déjà vu. Survey research suggests that people who experience both seizure-related and non-seizure déjà vu can often subjectively distinguish between the two. We present a case of a person with a history of focal MTL seizures who reports having experienced both seizure-related and non-seizure common déjà vu, though the non-seizure type was more frequent during this person's youth than it is currently. The patient was studied with a virtual tour paradigm that has previously been shown to elicit déjà vu among non-clinical, young adult participants. The patient reported experiencing déjà vu of the common non-seizure type during the virtual tour paradigm, without associated abnormalities of the intracranial EEG. We situate this work in the context of broader ongoing projects examining the subjective correlates of seizures. The importance for memory research of virtual scenes, spatial tasks, virtual reality (VR), and this paradigm for isolating familiarity in the context of recall failure are discussed.

Deficits in recent but not lifetime familiarity in amnestic mild cognitive impairment

People with amnestic mild cognitive impairment (aMCI) repeat questions, seemingly without any sense of familiarity (i.e., recognition of prior occurrence without recollection of episodic context). Accumulation of neurofibrillary tau in preclinical Alzheimer's disease begins in perirhinal cortex, a medial temporal lobe region linked to familiarity. Both observations would predict impaired familiarity assessment in aMCI; however, the extant evidence is mixed. To reveal familiarity impairments, it may be necessary to minimize the influence of recollection. In the current study, older adults with aMCI and healthy controls were administered two tasks on which a well-characterized patient (NB) with selective familiarity impairments due to surgical left temporal lobe excision sparing the hippocampus showed abnormal performance: frequency judgments for words exposed to in a recent study phase and judgments of cumulative lifetime familiarity for object concepts denoted by words. We also administered a process dissociation procedure (PDP) task that previously revealed spared familiarity in aMCI. We predicted that familiarity would be spared in aMCI on the PDP task, but impaired when assessed by frequency judgments for recent laboratory exposures and lifetime familiarity judgments. Familiarity was spared on the PDP task, but was impaired when probed with frequency judgments for recently exposed words in aMCI. Lifetime familiarity was also not impaired in aMCI. These results highlight the benefits of studying familiarity under conditions that minimize recollection and the value of frequency judgments in revealing familiarity deficits, and suggest that perirhinal cortex may not be necessary for accessing familiarity accumulated over a lifetime of experience.

Familiarity impairments after anterior temporal-lobe resection with hippocampal sparing: Lessons learned from case NB

We review evidence from an extensive single case study in an individual (NB) who underwent a rare left-sided anterior temporal-lobe resection with sparing of the hippocampus. Our study aimed to determine whether memory functions of perirhinal cortex, which was largely removed in the resection, can be impaired against a background of preserved hippocampus-dependent memory processing. This research was guided by the proposal that item-based familiarity assessment relies on contributions of perirhinal cortex, and that the hippocampus plays a unique role in the relational binding of items to episodic contexts, which is critical for recollection. Seven sets of findings have emerged from our research on NB (synthesized from five primary research articles), and from follow-up work in other patients: (i) Familiarity impairments can be selective and be revealed with multiple methods; (ii) selective familiarity and selective recollection impairments can be double dissociated; (iii) selective familiarity impairments show material specificity; (iv) selective familiarity impairments extend to assessment of cumulative lifetime experience; (v) selective familiarity impairments are sensitive to degree of feature overlap between object concepts; (vi) selective familiarity impairments are associated with preserved task-related fMRI signals in the hippocampus; (vii) selective familiarity impairments can be observed in other lesion cases. Despite our main focus on the dual-process framework, we also discuss implications for the functional organization of the medial temporal lobes in broader terms. We argue that our findings shed light on this organization even if the functional specialization of different medial temporal structures is ultimately not fully captured with reference to the cognitive distinction between familiarity and recollection.

Déjà vu and prescience in a case of severe episodic amnesia following bilateral hippocampal lesions

Several studies pertaining to déjà vu have consistently made a connection with the perirhinal region, a region located below the hippocampus. This idea is strengthened by the fact that déjà vu is an erroneous sense of familiarity and that familiarity appears to largely depend on the perirhinal region in healthy subjects. In this context, the role of the hippocampus is particularly unclear as it is unknown whether or not it plays a role in the genesis of déjà vu. We report on the case of OHVR, an epileptic patient who suffers from severe episodic amnesia related to massive isolated bilateral damage to the hippocampus. In contrast, the perirhinal region is intact structurally and functionally. This patient reports frequent déjà vu but also another experiential phenomenon with a prominent feeling of prescience, which shows some of the characteristics of déjà vécu. She clearly distinguishes both. She also developed a form of synaesthesia by attributing affective valence to numbers. This study shows that déjà vu can occur in cases of amnesia with massively damaged hippocampi and confirms that the perirhinal region is a core region for déjà vu, using a different approach from previous reports. It also provides clues about a potential influence of hippocampal alterations in déjà vécu.

Comparing the Wada Test and Functional MRI for the Presurgical Evaluation of Memory in Temporal Lobe Epilepsy

PURPOSE OF REVIEW

The usefulness of the Wada test (WT) predicting memory impairment from temporal lobe epilepsy (TLE) surgery has been debated, and it has progressively been replaced by functional MRI (fMRI). We review the current role of WT and fMRI in the presurgical assessment of TLE, and how novel surgical techniques might improve cognitive outcomes.

RECENT FINDINGS

fMRI's ability to predict global amnesia has not been assessed. Although WT can produce false-positive results, it is still indicated in patients at risk for developing global amnesia: those with significant bilateral or contralateral memory deficits. In the current review, WT exhibited no added value, beyond preclinical data, for predicting material-specific memory impairment, whereas fMRI was reliable for either verbal or non-verbal memory decline. Abnormal functional connectivity on resting state fMRI (rs-fMRI) between the posterior cingulate and the hippocampus may be a predictor of postsurgical memory outcomes. Restricted resections to the pathogenic tissue, stereotactic laser, radiosurgery, and SEEG-guided thermos-coagulation were associated with better cognitive outcome. fMRI should be used routinely in the presurgical workup of TLE to predict verbal and/or non-verbal memory decline, whereas WT may be indicated when there is a high risk of postsurgical global amnesia. Rs-fMRI is a promising tool for the presurgical workup of TLE, and more restricted resections are recommended to enhance cognitive outcomes.

Déjà vu and the feeling of prediction: an association with familiarity strength

A recent laboratory study by Cleary and Claxton [2018. Déjà vu: An illusion of prediction. Psychological Science, 29(4), 635-644. http://journals.sagepub.com/doi/full/10.1177/0956797617743018] documented a relationship between déjà vu and feelings of premonition. During instances of retrieval failure, participants reported stronger feelings of prediction during déjà vu than non-déjà vu states, despite displaying no actual predictive ability in such instances. The present study further explored the link between déjà vu reports and feelings of prediction. Although feelings of prediction were more likely to occur during reports of déjà vu than non-déjà vu, they were not the sole defining feature of déjà vu, accounting for just over half of all reported déjà vu states. Instances of déjà vu that were accompanied by feelings of prediction were associated with greater feelings of familiarity than instances that were not. This was shown by a greater likelihood of reporting that the scene felt familiar and also by a higher rated intensity of the feeling of familiarity elicited by the scene when it did feel familiar. Though the present study was mainly descriptive in characterising the interrelations between déjà vu, feelings of prediction, and familiarity, the full pattern points toward the possibility that high familiarity intensity may contribute to the feeling of prediction during déjà vu.

fMRI evidence supporting the role of memory conflict in the déjà vu experience

Attempts to generate déjà vu experimentally have largely focused on engineering partial familiarity for stimuli, relying on an ensuing, but unprompted evaluation of conflict to generate the experience. Without verification that experimentally-generated familiarity is accompanied by the awareness of stimulus novelty, these experimental procedures potentially provide an incomplete déjà vu analogue. We used a modified version of the Deese-Roediger-McDermott (DRM) false memory procedure to generate both familiarity and novelty within a déjà vu analogue - we coupled experimentally-generated familiarity with cues indicating that the familiarity was erroneous, using this additional source of mnemonic information to generate cognitive conflict in our participants. We collected fMRI and behavioural data from 21 participants, 16 of whom reported déjà vu. Using univariate contrasts we identified brain regions associated with mnemonic conflict, including the anterior cingulate cortex, medial prefrontal cortex and parietal cortex. This is the first experiment to image an analogue of the déjà vu experience in healthy volunteers. The increased likelihood of déjà vu reports to DRM critical lures correctly identified as "new", and the activation of neural substrates supporting the experience of cognitive conflict during déjà vu, suggest that the resolution of memory conflict may play an integral role in déjà vu.

Overcoming familiarity illusions in a single case with persistent déjà vu

While occasional déjà vu is benign in the general population, rare neuropsychological cases with persistent déjà vu have been described in the literature. We report the case of MN, a 25-year-old woman, who suffered a cerebral haemorrhage in the right thalamo-callosal region and experienced recurrent déjà vu episodes. Through clinical interviews and memory tasks related to déjà vu, we assumed that source memory errors and an inappropriate feeling of familiarity (measured by the number of false recognitions) were critically involved in MN's déjà vu. Based on this, we developed the first neuropsychological intervention dedicated to déjà vu. The rationale was to train MN to detect elements that could produce an inappropriate feeling of familiarity and to promote metacognitive awareness about déjà vu. This intervention was effective at reducing the frequency of déjà vu episodes in MN's daily life, as well as the number of false recognitions in memory tasks. In addition to its clinical contribution, this single-case study contributes to the limited literature on patients whose déjà vu is not related to epileptic abnormalities and medial temporal brain damage, and provide supportive evidence of the role of an erroneous feeling of familiarity and of metacognitive processes in déjà vu.

Abnormal rsFC and GMV changes in parahippocampal and DLPFC for high Déjà vu experienced subjects

How déjà vu works has long been a mystery, partially because of its characteristics of unpredictable occurrences and quick disappearances, which make it difficult to be explored. Previous studies have described the anatomical structures underlying déjà vu in healthy subjects; however, the functional mechanism of déjà vu remains unclear. Therefore, this study investigated the brain structural and functional components underlying déjà vu by combining voxel-based morphometry analysis (VBM) with resting-state functional connectivity (rsFC). The VBM analysis revealed that the anterior parahippocampal gyrus (PHG) had significantly less grey matter volume (GMV) in high déjà vu group than low group, confirming previous studies. Further functional connectivity analysis revealed that the frequency of déjà vu experiences was negatively correlated with the strength of the rsFC between anterior dorsal lateral prefrontal cortex (DLPFC) and anterior PHG but positively correlated with the strength of the rsFC between posterior DLPFC and posterior PHG. Moreover, the frequency of déjà vu experiences was negatively correlated with the strength of the rsFC between the anterior and posterior regions of the PHG. These findings indicated that familiarity without recollection (PHG) and superior context monitoring (DLPFC) are critical for real-life déjà vu experiences.

How landmark suitability shapes recognition memory signals for objects in the medial temporal lobes

A role of perirhinal cortex (PrC) in recognition memory for objects has been well established. Contributions of parahippocampal cortex (PhC) to this function, while documented, remain less well understood. Here, we used fMRI to examine whether the organization of item-based recognition memory signals across these two structures is shaped by object category, independent of any difference in representing episodic context. Guided by research suggesting that PhC plays a critical role in processing landmarks, we focused on three categories of objects that differ from each other in their landmark suitability as confirmed with behavioral ratings (buildings > trees > aircraft). Participants made item-based recognition-memory decisions for novel and previously studied objects from these categories, which were matched in accuracy. Multi-voxel pattern classification revealed category-specific item-recognition memory signals along the long axis of PrC and PhC, with no sharp functional boundaries between these structures. Memory signals for buildings were observed in the mid to posterior extent of PhC, signals for trees in anterior to posterior segments of PhC, and signals for aircraft in mid to posterior aspects of PrC and the anterior extent of PhC. Notably, item-based memory signals for the category with highest landmark suitability ratings were observed only in those posterior segments of PhC that also allowed for classification of landmark suitability of objects when memory status was held constant. These findings provide new evidence in support of the notion that item-based memory signals for objects are not limited to PrC, and that the organization of these signals along the longitudinal axis that crosses PrC and PhC can be captured with reference to landmark suitability.

Assessing a Metacognitive Account of Associative Memory Impairments in Temporal Lobe Epilepsy

Previous research has pointed to a deficit in associative recognition in temporal lobe epilepsy (TLE). Associative recognition tasks require discrimination between various combinations of words which have and have not been seen previously (such as old-old or old-new pairs). People with TLE tend to respond to rearranged old-old pairs as if they are “intact” old-old pairs, which has been interpreted as a failure to use a recollection strategy to overcome the familiarity of two recombined words into a new pairing. We examined this specific deficit in the context of metacognition, using postdecision confidence judgements at test. We expected that TLE patients would show inappropriate levels of confidence for associative recognition. Although TLE patients reported lower confidence levels in their responses overall, they were sensitive to the difficulty of varying pair types in their judgements and gave significantly higher confidence ratings for their correct answers. We conclude that a strategic deficit is not at play in the associative recognition of people with TLE, insofar as they are able to monitor the status of their memory system. This adds to a growing body of research suggesting that recollection is impaired in TLE, but not metacognition.

Distributed category-specific recognition-memory signals in human perirhinal cortex

Evidence from a large body of research suggests that perirhinal cortex (PrC), which interfaces the medial temporal lobe with the ventral visual pathway for object identification, plays a critical role in item-based recognition memory. The precise manner in which PrC codes for the prior occurrence of objects, however, remains poorly understood. In the present functional magnetic resonance imaging (fMRI) study, we used multivoxel pattern analyses to examine whether the prior occurrence of faces is coded by distributed patterns of PrC activity that consist of voxels with decreases as well as increases in signal. We also investigated whether pertinent voxels are preferentially tuned to the specific object category to which judged stimuli belong. We found that, when no a priori constraints were imposed on the direction of signal change, activity patterns that allowed for successful classification of recognition-memory decisions included some voxels with decreases and others with increases in signal in association with perceived prior occurrence. Moreover, successful classification was obtained in the absence of a mean difference in activity across the set of voxels in these patterns. Critically, we observed a positive relationship between classifier accuracy and behavioral performance across participants. Additional analyses revealed that voxels carrying diagnostic information for classification of memory decisions showed category specificity in their tuning for faces when probed with an independent functional localizer in a nonmnemonic task context. These voxels were spatially distributed in PrC, and extended beyond the contiguous voxel clusters previously described as the anterior temporal face patch. Our findings provide support for proposals, recently raised in the neurophysiological literature, that the prior occurrence of objects is coded by distributed PrC representations. They also suggest that the stimulus category to which an item belongs shapes the organization of these distributed representations.

Third International Congress on Epilepsy, Brain and Mind: Part 1

Epilepsy is both a disease of the brain and the mind. Here, we present the first of two papers with extended summaries of selected presentations of the Third International Congress on Epilepsy, Brain and Mind (April 3-5, 2014; Brno, Czech Republic). Epilepsy in history and the arts and its relationships with religion were discussed, as were overviews of epilepsy and relevant aspects of social cognition, handedness, accelerated forgetting and autobiographical amnesia, and large-scale brain networks.

The piriform, perirhinal, and entorhinal cortex in seizure generation

Understanding neural network behavior is essential to shed light on epileptogenesis and seizure propagation. The interconnectivity and plasticity of mammalian limbic and neocortical brain regions provide the substrate for the hypersynchrony and hyperexcitability associated with seizure activity. Recurrent unprovoked seizures are the hallmark of epilepsy, and limbic epilepsy is the most common type of medically-intractable focal epilepsy in adolescents and adults that necessitates surgical evaluation. In this review, we describe the role and relationships among the piriform (PIRC), perirhinal (PRC), and entorhinal cortex (ERC) in seizure-generation and epilepsy. The inherent function, anatomy, and histological composition of these cortical regions are discussed. In addition, the neurotransmitters, intrinsic and extrinsic connections, and the interaction of these regions are described. Furthermore, we provide evidence based on clinical research and animal models that suggest that these cortical regions may act as key seizure-trigger zones and, even, epileptogenesis.

Intrinsic mechanisms stabilize encoding and retrieval circuits differentially in a hippocampal network model

Acetylcholine regulates memory encoding and retrieval by inducing the hippocampus to switch between pattern separation and pattern completion modes. However, both processes can introduce significant variations in the level of network activity and potentially cause a seizure-like spread of excitation. Thus, mechanisms that keep network excitation within certain bounds are necessary to prevent such instability. We developed a biologically realistic computational model of the hippocampus to investigate potential intrinsic mechanisms that might stabilize the network dynamics during encoding and retrieval. The model was developed by matching experimental data, including neuronal behavior, synaptic current dynamics, network spatial connectivity patterns, and short-term synaptic plasticity. Furthermore, it was constrained to perform pattern completion and separation under the effects of acetylcholine. The model was then used to investigate the role of short-term synaptic depression at the recurrent synapses in CA3, and inhibition by basket cell (BC) interneurons and oriens lacunosum-moleculare (OLM) interneurons in stabilizing these processes. Results showed that when CA3 was considered in isolation, inhibition solely by BCs was not sufficient to control instability. However, both inhibition by OLM cells and short-term depression at the recurrent CA3 connections stabilized the network activity. In the larger network including the dentate gyrus, the model suggested that OLM inhibition could control the network during high cholinergic levels while depressing synapses at the recurrent CA3 connections were important during low cholinergic states. Our results demonstrate that short-term plasticity is a critical property of the network that enhances its robustness. Furthermore, simulations suggested that the low and high cholinergic states can each produce runaway excitation through unique mechanisms and different pathologies. Future studies aimed at elucidating the circuit mechanisms of epilepsy could benefit from considering the two modulatory states separately.

The awareness of novelty for strangely familiar words: a laboratory analogue of the déjà vu experience

Déjà vu is a nebulous memory experience defined by a clash between evaluations of familiarity and novelty for the same stimulus. We sought to generate it in the laboratory by pairing a DRM recognition task, which generates erroneous familiarity for critical words, with a monitoring task by which participants realise that some of these erroneously familiar words are in fact novel. We tested 30 participants in an experiment in which we varied both participant awareness of stimulus novelty and erroneous familiarity strength. We found that déjà vu reports were most frequent for high novelty critical words (∼25%), with low novelty critical words yielding only baseline levels of déjà vu report frequency (∼10%). There was no significant variation in déjà vu report frequency according to familiarity strength. Discursive accounts of the experimentally-generated déjà vu experience suggest that aspects of the naturalistic déjà vu experience were captured by this analogue, but that the analogue was also limited in its focus and prone to influence by demand characteristics. We discuss theoretical and methodological considerations relevant to further development of this procedure and propose that verifiable novelty is an important component of both naturalistic and experimental analogues of déjà vu.

In search of a recognition memory engram

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The role of the perirhinal cortex in familiarity discrimination is reviewed.

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Behavioural, pharmacological and electrophysiological evidence is considered.

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The cortex is found to be essential for memory acquisition, retrieval and storage.

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The evidence indicates that perirhinal synaptic weakening is critically involved.

A large body of data from human and animal studies using psychological, recording, imaging, and lesion techniques indicates that recognition memory involves at least two separable processes: familiarity discrimination and recollection. Familiarity discrimination for individual visual stimuli seems to be effected by a system centred on the perirhinal cortex of the temporal lobe. The fundamental change that encodes prior occurrence within the perirhinal cortex is a reduction in the responses of neurones when a stimulus is repeated. Neuronal network modelling indicates that a system based on such a change in responsiveness is potentially highly efficient in information theoretic terms. A review is given of findings indicating that perirhinal cortex acts as a storage site for recognition memory of objects and that such storage depends upon processes producing synaptic weakening.

VL: a further case of erroneous recollection

We report a single-case study of a female patient (VL) who exhibited frequent episodes of erroneous recollections triggered by everyday events. Based on neuropsychological testing, VL was classified as suffering from mild to moderate dementia (MMSE=18) and was given a diagnosis of probable Alzheimer׳s disease. Her memory functions were uniformly impaired but her verbal abilities were generally well preserved. A structural MRI scan showed extensive areas of gray matter atrophy particularly in frontal and medial-temporal (MTL) areas. Results of experimental recognition tests showed that VL had very high false alarm rates on tests using pictures, faces and auditory stimuli, but lower false alarm rates on verbal tests. We provide a speculative account of her erroneous recollections in terms of her MTL and frontal pathology. In outline, we suggest that owing to binding failures in MTL regions, VL׳s recognition processes were forced to rely on earlier than normal stages of analysis. Environmental features on a given recognition trial may have combined with fragments persisting from previous trials resulting in erroneous feelings of familiarity and of recollection that were not discounted or edited out, due to her impaired frontal processes.

The lateralizing and localizing value of peri-ictal cough in epileptic seizures

Introduction.Coughing may be observed as an epiphenomenon during or after epileptic seizures.

Aim.In this paper we discuss the lateralization and localization value of cough as an epileptic peri/post ictal semiological phenomenon.

Material and Methods.Seven patients presenting cough as a part of their symptomatology are presented. We will discuss cough in the context of these seven patients.

Results.Six out of these seven patients were multidrug resistant temporal lobe epilepsy patients, all were right handed. They were all examined for possible epilepsy surgery and four underwent surgery with complete seizure freedom. We do not have certain evidence for lateralization in one patient with hot water epilepsy though déjà vu as an initial symptom in this patient implies a temporal lobe onset. The seven other patients had temporal lobe epilepsy. Among the patients who had surgery, three had left sided and one had right sided temporal lobe surgery with consequent seizure freedom.

Conclusion.Referring to the argument in the literature, with our small patient sample, we might conclude that cough has significant value in localizing seizures to the temporal lobe but overall these limited data do not suggest a lateralizing value.

Déjà vu experiences in healthy subjects are unrelated to laboratory tests of recollection and familiarity for word stimuli

Recent neuropsychological and neuroscientific research suggests that people who experience more déjà vu display characteristic patterns in normal recognition memory. We conducted a large individual differences study (n = 206) to test these predictions using recollection and familiarity parameters recovered from a standard memory task. Participants reported déjà vu frequency and a number of its correlates, and completed a recognition memory task analogous to a Remember-Know procedure. The individual difference measures replicated an established correlation between déjà vu frequency and frequency of travel, and recognition performance showed well-established word frequency and accuracy effects. Contrary to predictions, no relationships were found between déjà vu frequency and recollection or familiarity memory parameters from the recognition test. We suggest that déjà vu in the healthy population reflects a mismatch between errant memory signaling and memory monitoring processes not easily characterized by standard recognition memory task performance.

Distinct familiarity-based response patterns for faces and buildings in perirhinal and parahippocampal cortex

An unresolved question in our understanding of the medial temporal lobes is how functional differences between structures pertaining to stimulus category relate to the distinction between item-based and contextually based recognition-memory processes. Specifically, it remains unclear whether perirhinal cortex (PrC) supports item-based familiarity signals for all stimulus categories or whether parahippocampal cortex (PhC) may also play a role for stimulus categories that are known to engage this structure in other task contexts. Here, we used multivoxel pattern analyses of fMRI data to compare patterns of activity in humans that are associated with the perceived familiarity of faces, buildings, and chairs. During scanning, participants judged the familiarity of previously studied and novel items from all three categories. Instances in which recognition was based on recollection were removed from all analyses. In right PrC, we found patterns of activity that distinguished familiar from novel faces. By contrast, in right PhC, we observed such patterns for buildings. Familiarity signals for chairs were present in both structures but shared little overlap with the patterns observed for faces and buildings on a more fine-grained scale. In the hippocampus, we found no evidence for familiarity signals for any object category. Our findings show that both PrC and PhC contribute to the assessment of item familiarity. They suggest that PhC does not only represent episodic context but can also represent item information for some object categories in recognition-memory decisions. In turn, our findings also indicate that the involvement of PrC in representing item familiarity is not ubiquitous.