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Sanchez-Larsen A, Principe A, Ley M, Vaquerizo B, Langohr K, Rocamora R. Insular Role in Blood Pressure and Systemic Vascular Resistance Regulation. Neuromodulation 2023:S1094-7159(23)00006-5. [PMID: 36682902 DOI: 10.1016/j.neurom.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The insula is a brain area involved in the modulation of autonomic responses. Previous studies have focused mainly on its heart rate regulatory function, but its role in vascular control is not well defined. Ictal/postictal blood pressure (BP) fluctuations may have a role in the pathogenesis of sudden unexpected death in epilepsy. This study aims to characterize the insular influence on vascular regulation through direct high-frequency electrical stimulation (E-stim) of different insular regions during stereo-electroencephalographic studies. MATERIALS AND METHODS An observational, prospective study was conducted, involving people with epilepsy who underwent E-stim of depth electrodes implanted in the insular cortex. Patients with anatomical or electrophysiological insular abnormalities, E-stim producing after discharges, or any elicited symptoms were excluded. Variations of BP and systemic vascular resistance (SVR) during the insular stimuli were analyzed, comparing them with those observed during E-stim of control contacts implanted in cortical noneloquent regions and sham stimulations. RESULTS Fourteen patients were included, five implanted in the right insula and nine in the left. We analyzed 14 stimulations in the right insula, 18 in the left insula, 18 in control electrodes, and 13 sham stimulations. Most right insular responses were hypertensive, whereas most left ones were hypotensive. E-stim of the right insula produced a significant BP and SVR increase, whereas the left insula induced a significant BP decrease without SVR changes. The most remarkable changes were elicited in both posterior insulas, although the magnitude of BP changes was generally low. Control and sham stimulations did not induce BP or SVR changes. CONCLUSION Our findings on insular stimulation suggest an interhemispheric difference in its vascular regulatory function, with a vasopressor effect of the right insula and a vasodilator effect of the left one.
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Affiliation(s)
- Alvaro Sanchez-Larsen
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Principe
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Miguel Ley
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Epilepsy Monitoring Unit, Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Beatriz Vaquerizo
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Klaus Langohr
- Integrative Pharmacology and Systems Neuroscience Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Statistics and Operations Research, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain
| | - Rodrigo Rocamora
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain
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Delgado G, Estañol B, Rodríguez-Violante M, Martínez-Memije R, Infante-Vázquez Ó, Bertado-Ramírez N. Cardiovascular variability in Mexican patients with Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:762-7. [DOI: 10.1590/0004-282x20140125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
Cardiovascular variability (CVV) has been evaluated in patients with Parkinson's disease (PD) in other countries and exhibit ethnic differences. Objective We investigated heart rate variability (HRV) and blood pressure variability (BPV) in Mexican patients with PD. Method We further compared HRV and BPV between this group and young healthy controls (YHC) in order to estimate, for the first time in our country, the magnitude of the difference. Twenty patients were examined. Time- and frequency-domain CVV parameters were studied during supine rest (SR), active standing (AS) and controlled breathing. These measurements were compared to those of 20 YHC. Results In the three conditions tested, our study showed a decrease in almost all HRV parameters in PD patients; on the contrary, decreased BPV parameters were found less frequently and only during SR and AS. Conclusion Our results indicate that HRV is impaired in PD. Some BPV parameters are also diminished.
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Affiliation(s)
- Guillermo Delgado
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico
| | - Bruno Estañol
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico
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Soueidan K, Chen S, Dajani HR, Bolic M, Groza V. Augmented blood pressure measurement through the noninvasive estimation of physiological arterial pressure variability. Physiol Meas 2012; 33:881-99. [DOI: 10.1088/0967-3334/33/6/881] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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