1
|
Leo DG, Keller SS, Proietti R. "Close your eyes and relax": the role of hypnosis in reducing anxiety, and its implications for the prevention of cardiovascular diseases. Front Psychol 2024; 15:1411835. [PMID: 39035095 PMCID: PMC11258040 DOI: 10.3389/fpsyg.2024.1411835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
Anxiety is the most common form of mental health disorder, affecting millions of people worldwide. Psychosocial interventions such as mindfulness and cognitive behavioral therapy (CBT) have been suggested as an effective treatment in the management of general anxiety and anxiety disorders, with emerging evidence also suggesting the effectiveness of hypnosis. Moreover, anxiety has shown to be linked to the onset and development of several cardiovascular diseases (CVD), which are the leading cause of global death. In this paper, we review the current literature to examine the role that anxiety has on the onset and development of CVD and summarize the current knowledge on the role that hypnosis and hypnotherapy have in reducing anxiety, also explaining how this can impact the cardiovascular system and the prevention of CVD. Review of the evidence suggests that hypnosis and hypnotherapy are effective in treating anxiety and may positively affect the heart and the cardiovascular system, reducing sympathetic activation and increasing parasympathetic tone, potentially preventing the onset of CVD related to increased sympathetic activation. However, further studies are required to further understand how hypnosis and hypnotherapy affect the cardiovascular system through investigation of the neurophysiological components of the hypnotic state and of the mind-body relationship. Healthcare systems should embed mental health screening in patients at risk of developing CVD as part of the clinical pathway and consider the role that hypnosis and hypnotherapy may play in the management of CVD.
Collapse
Affiliation(s)
- Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Science, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Simon S. Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Riccardo Proietti
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Science, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
2
|
Albuquerque LAF, de Macêdo Filho LJM, Borges FS, Diógenes GS, Pessoa FC, Rocha CJV, Almeida JP, Ghizoni E, Joaquim AF. Performance of intraoperative neurocognitive tests during awake surgery for patients with diffuse low-grade glioma. Neurosurg Rev 2024; 47:129. [PMID: 38532178 DOI: 10.1007/s10143-024-02364-6] [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: 12/01/2023] [Revised: 02/17/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024]
Abstract
Despite great advancements and the diffusion of awake surgery for brain tumors, the literature shows that the tests applied during the procedure are heterogeneous and non-standardized. This prospective, observational, descriptive study collected data on intraoperative brain mapping and the performance of multiple neurocognitive tests in 51 awake surgeries for diffuse low-grade glioma. Frequency of use and rate of intraoperative findings of different neurocognitive tests were analyzed. Patients mean age at the time of surgery was 35.1 (20-57) years. We performed 26 (51.0%) surgeries on the left hemisphere (LH) and 25 (49.0%) on the right hemisphere (RH). Significant differences were observed between the total number of functional findings (cortical and subcortical) identified in the LH and RH (p = 0.004). In subcortical findings alone, the differences remained significant (p = 0.0004). The RH subcortical region showed the lowest number of intraoperative findings, and this was correlated with functional outcome: Karnofsky performance scale at five days (p = 0.022), three months (p = 0.002) and one year (p = 0.002) post-surgery. On average, more tests were used to map the RH, with a lower frequency of both cortical and subcortical functional findings. Even though subcortical findings were less frequent than cortical findings, they were crucial to defining the resection margins. Based on the intraoperative findings, frequency of use, and rate of findings per use of the tests analyzed, the most relevant tests for each hemisphere for awake brain mapping were identified.
Collapse
Affiliation(s)
- Lucas Alverne F Albuquerque
- Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil.
- Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil.
| | | | - Felipe Silva Borges
- Department of Anesthesiology, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | | | - Fátima C Pessoa
- Speech Therapist, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | | | | | - Enrico Ghizoni
- Division of Neurosurgery, Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil
| | - Andrei F Joaquim
- Division of Neurosurgery, Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil
| |
Collapse
|
3
|
Bermúdez G, Quiñones I, Carrasco A, Gil-Robles S, Amoruso L, Mandonnet E, Carreiras M, Catalán G, Pomposo I. A novel cognitive neurosurgery approach for supramaximal resection of non-dominant precuneal gliomas: a case report. Acta Neurochir (Wien) 2023; 165:2747-2754. [PMID: 37597007 PMCID: PMC10541831 DOI: 10.1007/s00701-023-05755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/26/2023] [Indexed: 08/21/2023]
Abstract
Despite mounting evidence pointing to the contrary, classical neurosurgery presumes many cerebral regions are non-eloquent, and therefore, their excision is possible and safe. This is the case of the precuneus and posterior cingulate, two interacting hubs engaged during various cognitive functions, including reflective self-awareness; visuospatial and sensorimotor processing; and processing social cues. This inseparable duo ensures the cortico-subcortical connectivity that underlies these processes. An adult presenting a right precuneal low-grade glioma invading the posterior cingulum underwent awake craniotomy with direct electrical stimulation (DES). A supramaximal resection was achieved after locating the superior longitudinal fasciculus II. During surgery, we found sites of positive stimulation for line bisection and mentalizing tests that enabled the identification of surgical corridors and boundaries for lesion resection. When post-processing the intraoperative recordings, we further identified areas that positively responded to DES during the trail-making and mentalizing tests. In addition, a clear worsening of the patient's self-assessment ability was observed throughout the surgery. An awake cognitive neurosurgery approach allowed supramaximal resection by reaching the cortico-subcortical functional limits. The mapping of complex functions such as social cognition and self-awareness is key to preserving patients' postoperative cognitive health by maximizing the ability to resect the lesion and surrounding areas.
Collapse
Affiliation(s)
- Garazi Bermúdez
- Neurosurgery Service, Cruces Universitary Hospital, Barakaldo, Spain
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Ileana Quiñones
- Neurobiology of Language, Basque Center On Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain.
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
| | - Alejandro Carrasco
- Neurosurgery Service, Cruces Universitary Hospital, Barakaldo, Spain
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Santiago Gil-Robles
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- Neurosurgery Service, Quironsalud Madrid Universitary Hospital, Madrid, Spain
| | - Lucia Amoruso
- Neurobiology of Language, Basque Center On Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Emmanel Mandonnet
- Lariboisière Hospital, Université Paris 7 Diderot, Paris, France
- Frontlab, CNRS UMR 7225, INSERM U1127, Paris, France
| | - Manuel Carreiras
- University of the Basque Country, UPV/EHU, Bilbao, Spain
- Neurobiology of Language, Basque Center On Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Gregorio Catalán
- Neurosurgery Service, Cruces Universitary Hospital, Barakaldo, Spain
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Iñigo Pomposo
- Neurosurgery Service, Cruces Universitary Hospital, Barakaldo, Spain
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
| |
Collapse
|
4
|
Foster BL, Koslov SR, Aponik-Gremillion L, Monko ME, Hayden BY, Heilbronner SR. A tripartite view of the posterior cingulate cortex. Nat Rev Neurosci 2023; 24:173-189. [PMID: 36456807 PMCID: PMC10041987 DOI: 10.1038/s41583-022-00661-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
Abstract
The posterior cingulate cortex (PCC) is one of the least understood regions of the cerebral cortex. By contrast, the anterior cingulate cortex has been the subject of intensive investigation in humans and model animal systems, leading to detailed behavioural and computational theoretical accounts of its function. The time is right for similar progress to be made in the PCC given its unique anatomical and physiological properties and demonstrably important contributions to higher cognitive functions and brain diseases. Here, we describe recent progress in understanding the PCC, with a focus on convergent findings across species and techniques that lay a foundation for establishing a formal theoretical account of its functions. Based on this converging evidence, we propose that the broader PCC region contains three major subregions - the dorsal PCC, ventral PCC and retrosplenial cortex - that respectively support the integration of executive, mnemonic and spatial processing systems. This tripartite subregional view reconciles inconsistencies in prior unitary theories of PCC function and offers promising new avenues for progress.
Collapse
Affiliation(s)
- Brett L Foster
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Seth R Koslov
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lyndsey Aponik-Gremillion
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.,Department of Health Sciences, Dumke College for Health Professionals, Weber State University, Ogden, UT, USA
| | - Megan E Monko
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Y Hayden
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA.,Center for Magnetic Resonance Research and Center for Neural Engineering, University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
5
|
Duffau H. New Philosophy, Clinical Pearls, and Methods for Intraoperative Cognition Mapping and Monitoring "à la carte" in Brain Tumor Patients. Neurosurgery 2021; 88:919-930. [PMID: 33463689 DOI: 10.1093/neuros/nyaa363] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/23/2020] [Indexed: 11/13/2022] Open
Abstract
The purpose of surgery for brain tumors involving eloquent neural circuits is to maximize the extent of resection while preserving an optimal quality of life. To this end, especially in diffuse glioma, the goal is to remove the cerebral parenchyma invaded by the neoplasm up to the individual cortico-subcortical networks critical for brain functions. Intraoperative mapping combined with real-time cognitive monitoring throughout the resection in awake patient is thus highly recommended to resume a normal life. Indeed, beyond avoiding hemiplegia or aphasia, enjoying a familial, social, and professional life implies that motor and language mapping is not sufficient. Identifying and sparing neural networks that subserve cognition (movement control, visuospatial cognition, executive functions, multimodal semantics, metacognition) and mentalizing (theory of mind, which plays a key role for social cognition) is essential to preserve an adapted behavior. Here, the aim is to review when and how to map these critical functions, which have nonetheless been neglected for many decades by neurosurgeons. In fact, the disorders generated by surgical injuries of circuits underpinning nonmotor and nonspeech functions are usually not immediately visible on postoperative standard clinical examination, leading the physician to believe that the patient has no deficit. Yet, cognitive or emotional disturbances may subsequently prevent to resume an active life, as to work full time. Therefore, a systematic neuropsychological assessment should be performed before, during, and after mapping-guided surgery, regardless of the tumor location, to preserve the functional connectome intraoperatively and to plan a postoperative tailored cognitive rehabilitation according to the patient's needs.
Collapse
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| |
Collapse
|
6
|
Herbet G. Should Complex Cognitive Functions Be Mapped With Direct Electrostimulation in Wide-Awake Surgery? A Network Perspective. Front Neurol 2021; 12:635439. [PMID: 33912124 PMCID: PMC8072013 DOI: 10.3389/fneur.2021.635439] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Guillaume Herbet
- Institute of Functional Genomics, INSERM, CNRS, University of Montpellier, Montpellier, France.,Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| |
Collapse
|
7
|
Duffau H. Updated perspectives on awake neurosurgery with cognitive and emotional assessment for patients with low-grade gliomas. Expert Rev Neurother 2021; 21:463-473. [PMID: 33724148 DOI: 10.1080/14737175.2021.1901583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Thanks to early extensive surgical resection combined with medical oncological therapies, life expectancy dramatically increased in low-grade glioma (LGG), with an overall survival currently over 15 years. Therefore, patients should be able to maintain valuable family and socio-professional activities.Areas covered: For many decades, cognitive and emotional aspects were neglected by surgical and medical neurooncologists. The goal of surgery was to avoid hemiplegia and/or aphasia, with no considerations regarding behavior. However, because LGG patients live longer, they must be cognitively and affectively able to make long-term projects. Preservation of higher-order functions should be considered systematically in LGG surgery by means of awake cognitive/emotional mapping and monitoring.Expert opinion: The aim is to incorporate recent advances in neurosciences, which proposed revisited models of cerebral processing relying on a meta-network perspective, into the pre-, intra- and postoperative procedure. In this connectomal approach, brain functions result from complex interactions within and between neural networks. This improved understanding of a constant instability of the neural system allows a better cognitive/emotional assessment before and after each treatment over years, in order to preserve personality and adaptive behavior for each LGG patient, based on his/her own definition of quality of life. It is time to create oncological neurosciences.
Collapse
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery Gui De Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1191 Laboratory Team "Brain Plasticity, Stem Cells and Low-Grade Gliomas", Institute of Functional Genomic, University of Montpellier, Montpellier, France
| |
Collapse
|
8
|
Klein C, Barron AB. How experimental neuroscientists can fix the hard problem of consciousness. Neurosci Conscious 2020; 2020:niaa009. [PMID: 32695476 PMCID: PMC7362610 DOI: 10.1093/nc/niaa009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 01/06/2023] Open
Abstract
For the materialist, the hard problem is fundamentally an explanatory problem. Solving it requires explaining why the relationship between brain and experience is the way it is and not some other way. We use the tools of the interventionist theory of explanation to show how a systematic experimental project could help move beyond the hard problem. Key to this project is the development of second-order interventions and invariant generalizations. Such interventions played a crucial scientific role in untangling other scientific mysteries, and we suggest that the same will be true of consciousness. We further suggest that the capacity for safe and reliable self-intervention will play a key role in overcoming both the hard and meta-problems of consciousness. Finally, we evaluate current strategies for intervention, with an eye to how they might be improved.
Collapse
Affiliation(s)
- Colin Klein
- School of Philosophy, The Australian National University, Canberra, ACT 0200, Australia
| | - Andrew B Barron
- Department of Biological Sciences, Macquarie University, North Ryde, NSW 2109, Australia
| |
Collapse
|
9
|
Maldonado IL, Parente de Matos V, Castro Cuesta TA, Herbet G, Destrieux C. The human cingulum: From the limbic tract to the connectionist paradigm. Neuropsychologia 2020; 144:107487. [PMID: 32470344 DOI: 10.1016/j.neuropsychologia.2020.107487] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 03/22/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Abstract
The cingulum is a core component of the limbic lobe and part of the circuit that was described by Papez where environmental experiences become endowed with emotional awareness. Recent techniques for the study of cerebral connectivity have updated this fasciculus' morphology and led to the acknowledgment that its involvement in superior functions goes far beyond emotion processing. Long and robust, the cingulum is a long association fasciculus with terminations in all cerebral lobes. These observations plead for a pivotal rethinking of its role in the human brain and lead to the conclusion that to merely consider it as the main fasciculus of the limbic system was actually a reductionism. This paper summarizes the key facts regarding why the cingulum is now perceived as a primary interconnecting apparatus in the medial aspect of the cerebral hemisphere.
Collapse
Affiliation(s)
- Igor Lima Maldonado
- UMR Inserm U1253, IBrain, Université de Tours, Tours, France; Le Studium Loire Valley Institute for Advanced Studies, Orleans, France; CHRU de Tours, Tours, France; Departamento de Biomorfologia - Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação Em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil.
| | | | - Taryn Ariadna Castro Cuesta
- Programa de Pós-Graduação Em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; University of Montpellier, Institute of Functional Genomics, INSERM, 1191, Montpellier, France
| | - Christophe Destrieux
- UMR Inserm U1253, IBrain, Université de Tours, Tours, France; CHRU de Tours, Tours, France; Laboratory of Anatomy, Faculté de Médecine, 10 Bd Tonnellé, 37032, Tours, France
| |
Collapse
|
10
|
Herbet G, Duffau H. Revisiting the Functional Anatomy of the Human Brain: Toward a Meta-Networking Theory of Cerebral Functions. Physiol Rev 2020; 100:1181-1228. [PMID: 32078778 DOI: 10.1152/physrev.00033.2019] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
For more than one century, brain processing was mainly thought in a localizationist framework, in which one given function was underpinned by a discrete, isolated cortical area, and with a similar cerebral organization across individuals. However, advances in brain mapping techniques in humans have provided new insights into the organizational principles of anatomo-functional architecture. Here, we review recent findings gained from neuroimaging, electrophysiological, as well as lesion studies. Based on these recent data on brain connectome, we challenge the traditional, outdated localizationist view and propose an alternative meta-networking theory. This model holds that complex cognitions and behaviors arise from the spatiotemporal integration of distributed but relatively specialized networks underlying conation and cognition (e.g., language, spatial cognition). Dynamic interactions between such circuits result in a perpetual succession of new equilibrium states, opening the door to considerable interindividual behavioral variability and to neuroplastic phenomena. Indeed, a meta-networking organization underlies the uniquely human propensity to learn complex abilities, and also explains how postlesional reshaping can lead to some degrees of functional compensation in brain-damaged patients. We discuss the major implications of this approach in fundamental neurosciences as well as for clinical developments, especially in neurology, psychiatry, neurorehabilitation, and restorative neurosurgery.
Collapse
Affiliation(s)
- Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," INSERM U1191, Institute of Functional Genomics, Montpellier, France; and University of Montpellier, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," INSERM U1191, Institute of Functional Genomics, Montpellier, France; and University of Montpellier, Montpellier, France
| |
Collapse
|
11
|
Leech R, Smallwood J. The posterior cingulate cortex: Insights from structure and function. HANDBOOK OF CLINICAL NEUROLOGY 2019; 166:73-85. [PMID: 31731926 DOI: 10.1016/b978-0-444-64196-0.00005-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The posterior cingulate cortex (PCC) (Brodmann areas 23/31) is one of the least well-understood regions of the cortex. The PCC has very high levels of metabolic consumption, and network analyses of functional and structural data suggest it is a core hub in the human connectome; however, contemporary neuroscience lacks a clear account of its functional significance. Consequently, many studies over the last decade have focused on understanding the role this region plays in cognition, particularly given its apparent tendency to deactivate during demanding external tasks. Consistent with the cytoarchitecture, recent work, leveraging complex analytical approaches, highlight that the connections the PCC forms with other regions are heterogeneous, going beyond a single network, while recent studies of its function highlight a role in a wide range of complex forms of cognition including memory, navigation, and narrative comprehension. This constellation of observations highlights a role for PCC in a set of cognitive processes that are supported by internal representations but may lack a common type of representational content. Together, these structural and functional studies contribute to an emerging view of the PCC as contributing to how cognition unfolds rather than what it is focused on.
Collapse
Affiliation(s)
- Robert Leech
- Department of Neuroimaging, King's College London, London, United Kingdom.
| | | |
Collapse
|
12
|
Abstract
The use of intraoperative cognitive mapping and monitoring during awake surgery is not new, but this surgical approach has undergone important changes in recent years, especially in the context of low-grade glioma surgery. This rapid development is related to the growing awareness from neurosurgeons that sustaining quality of life in patients with a long-survival expectancy implies assessment and preservation of a range of important functions during surgery, beyond "overt" functions, such as language or motricity. Here we describe the different behavioral paradigms typically used, and how they are selected and modulated to identify and spare critical brain-wide cognitive systems.
Collapse
Affiliation(s)
- Guillaume Herbet
- Department of Neurosurgery, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier 34295, France; Institute for Neuroscience of Montpellier, Saint-Eloi Hospital, INSERM U1051, University of Montpellier, 80, Avenue Augustin Fliche, Montpellier 34091, France.
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier 34295, France; Institute for Neuroscience of Montpellier, Saint-Eloi Hospital, INSERM U1051, University of Montpellier, 80, Avenue Augustin Fliche, Montpellier 34091, France
| |
Collapse
|
13
|
Duffau H. The error of Broca: From the traditional localizationist concept to a connectomal anatomy of human brain. J Chem Neuroanat 2018; 89:73-81. [DOI: 10.1016/j.jchemneu.2017.04.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 03/06/2017] [Accepted: 04/12/2017] [Indexed: 11/16/2022]
|
14
|
Demarquay G, Ducros A, Montavont A, Mauguiere F. Migraine with brainstem aura: Why not a cortical origin? Cephalalgia 2017; 38:1687-1695. [PMID: 29073774 DOI: 10.1177/0333102417738251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Migraine with brainstem aura is defined as a migraine with aura including at least two of the following symptoms: dysarthria, vertigo, tinnitus, hypacusis, diplopia, ataxia and/or decreased level of consciousness. Aim The aim of this study is to review data coming from clinical observations and functional mapping that support the role of the cerebral cortex in the initiation of brainstem aura symptoms. Results Vertigo can result from a vestibular cortex dysfunction, while tinnitus and hypacusis can originate within the auditory cortex. Diplopia can reflect a parieto-occipital involvement. Dysarthria can be caused by dysfunctions located in precentral gyri. Ataxia can reflect abnormal processing of vestibular, sensory, or visual inputs by the parietal lobe. Alteration of consciousness can be caused by abnormal neural activation within specific consciousness networks that include prefrontal and posterior parietal cortices. Conclusion Any symptom of so-called brainstem aura can originate within the cortex. Based on these data, we suggest that brainstem aura could have a cortical origin. This hypothesis would explain the co-occurrence of typical and brainstem aura during attacks and would fit with the theory of cortical spreading depression. We propose that migraine with brainstem aura should be classified as a typical migraine aura.
Collapse
Affiliation(s)
- Geneviève Demarquay
- 1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.,2 Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Lyon, France
| | - Anne Ducros
- 3 Department of Neurology, Montpellier University Hospital, France.,4 Medical School of Montpellier University (UM), France
| | | | - François Mauguiere
- 1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.,5 Lyon Neuroscience Research Center (CRNL), Neuropain team, INSERM U1028, CNRS UMR5292, Lyon, France.,6 Lyon 1 University, Lyon, France
| |
Collapse
|
15
|
Vilasboas T, Herbet G, Duffau H. Challenging the Myth of Right Nondominant Hemisphere: Lessons from Corticosubcortical Stimulation Mapping in Awake Surgery and Surgical Implications. World Neurosurg 2017; 103:449-456. [DOI: 10.1016/j.wneu.2017.04.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
|
16
|
Kyeong S, Choi SH, Eun Shin J, Lee WS, Yang KH, Chung TS, Kim JJ. Functional connectivity of the circadian clock and neural substrates of sleep-wake disturbance in delirium. Psychiatry Res Neuroimaging 2017; 264:10-12. [PMID: 28390292 DOI: 10.1016/j.pscychresns.2017.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 01/06/2023]
Abstract
A possible mechanism of disrupted circadian rhythms in delirium was identified using resting-state functional connectivity. Thirty-four delirious patients and 38 non-delirious controls were scanned for resting-state functional MRI. Seed-based connectivity of the suprachiasmatic nucleus was compared between the groups. In delirious patients functional connectivity from the circadian clock was increased to the dorsal anterior cingulate cortex and decreased to the posterior cingulate cortex, parahippocampal gyrus, cerebellum, and thalamus. A dysregulation of the default mode network and mental coordination processing areas by the circadian clock may be the underlying pathophysiology of sleep-wake cycle disturbance and symptom fluctuation in delirium.
Collapse
Affiliation(s)
- Sunghyon Kyeong
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Suk Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hyun Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Sub Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
17
|
Yordanova Y, Duffau H. Supratotal resection of diffuse gliomas – an overview of its multifaceted implications. Neurochirurgie 2017; 63:243-249. [DOI: 10.1016/j.neuchi.2016.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/20/2016] [Accepted: 09/27/2016] [Indexed: 12/25/2022]
|
18
|
Huberfeld G, Trébuchon A, Capelle L, Badier JM, Chen S, Lefaucheur JP, Gavaret M. Preoperative and intraoperative neurophysiological investigations for surgical resections in functional areas. Neurochirurgie 2017; 63:142-149. [DOI: 10.1016/j.neuchi.2016.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 01/23/2023]
|
19
|
Hodotopy, neuroplasticity and diffuse gliomas. Neurochirurgie 2017; 63:259-265. [DOI: 10.1016/j.neuchi.2016.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 11/25/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
|
20
|
Malagurski B, Péran P, Sarton B, Riu B, Gonzalez L, Vardon-Bounes F, Seguin T, Geeraerts T, Fourcade O, de Pasquale F, Silva S. Neural signature of coma revealed by posteromedial cortex connection density analysis. NEUROIMAGE-CLINICAL 2017; 15:315-324. [PMID: 28560156 PMCID: PMC5440358 DOI: 10.1016/j.nicl.2017.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/27/2017] [Accepted: 03/28/2017] [Indexed: 01/15/2023]
Abstract
Posteromedial cortex (PMC) is a highly segregated and dynamic core, which appears to play a critical role in internally/externally directed cognitive processes, including conscious awareness. Nevertheless, neuroimaging studies on acquired disorders of consciousness, have traditionally explored PMC as a homogenous and indivisible structure. We suggest that a fine-grained description of intrinsic PMC topology during coma, could expand our understanding about how this cortical hub contributes to consciousness generation and maintain, and could permit the identification of specific markers related to brain injury mechanism and useful for neurological prognostication. To explore this, we used a recently developed voxel-based unbiased approach, named functional connectivity density (CD). We compared 27 comatose patients (15 traumatic and 12 anoxic), to 14 age-matched healthy controls. The patients' outcome was assessed 3 months later using Coma Recovery Scale-Revised (CRS-R). A complex pattern of decreased and increased connections was observed, suggesting a network imbalance between internal/external processing systems, within PMC during coma. The number of PMC voxels with hypo-CD positive correlation showed a significant negative association with the CRS-R score, notwithstanding aetiology. Traumatic injury specifically appeared to be associated with a greater prevalence of hyper-connected (negative correlation) voxels, which was inversely associated with patient neurological outcome. A logistic regression model using the number of hypo-CD positive and hyper-CD negative correlations, accurately permitted patient's outcome prediction (AUC = 0.906, 95%IC = 0.795–1). These points might reflect adaptive plasticity mechanism and pave the way for innovative prognosis and therapeutics methods. A twofold pattern of decreased and increased connections within PMC was observed during coma. The number of PMC voxels with decreased positive connections, was significantly associated with patient's outcome. Greater prevalence of hyperconnected PMC voxels in traumatic brain injury was correlated to outcome in this subgroup.
Collapse
Key Words
- Acute brain injury
- BI, brain injury
- BOLD, blood oxygen level–dependent
- CDN, connection density based on negative correlation
- CDP, connection density based on positive correlation
- CRS-R, Coma Recovery Scale–Revised
- Coma
- Connection density
- DMN, default-mode network
- DOC, disorders of consciousness
- PCC, posterior cingulate cortex
- PMC, posteromedial cortex
- PreCu, precuneus
- Prognosis
- Resting state
- TBI, traumatic brain injury
- mPFC, medial prefrontal cortex
Collapse
Affiliation(s)
| | - Patrice Péran
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Benjamine Sarton
- Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Beatrice Riu
- Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Leslie Gonzalez
- Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Fanny Vardon-Bounes
- Critical Care Unit, University Teaching Hospital of Rangueil, F-31060 Toulouse Cedex 9, France
| | - Thierry Seguin
- Critical Care Unit, University Teaching Hospital of Rangueil, F-31060 Toulouse Cedex 9, France
| | - Thomas Geeraerts
- Neurocritical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Olivier Fourcade
- Neurocritical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Francesco de Pasquale
- ITAB, Department of Neuroscience Imaging and Clinical Science, G. D'Annunzio University, Chieti, Italy
| | - Stein Silva
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France.
| |
Collapse
|
21
|
Foster BL, Parvizi J. Direct cortical stimulation of human posteromedial cortex. Neurology 2017; 88:685-691. [PMID: 28100728 DOI: 10.1212/wnl.0000000000003607] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/17/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The posteromedial cortex (PMC) is a collective term for an anatomically heterogeneous area of the brain constituting a core node of the human default mode network (DMN), which is engaged during internally focused subjective cognition such as autobiographical memory. METHODS We explored the effects of causal perturbations of PMC with direct electric brain stimulation (EBS) during presurgical epilepsy monitoring with intracranial EEG electrodes. RESULTS Data were collected from 885 stimulations in 25 patients implanted with intracranial electrodes across the PMC. While EBS of regions immediately dorsal or ventral to the PMC reliably produced somatomotor or visual effects, respectively, we found no observable behavioral or subjectively reported effects when sites within the boundaries of PMC were electrically perturbed. In each patient, null effects of PMC stimulation were observed for sites in which intracranial recordings had clearly demonstrated electrophysiologic responses during autobiographical recall. CONCLUSIONS Direct electric modulation of the human PMC produced null effects when standard functional mapping methods were used. More sophisticated stimulation paradigms (e.g., EBS during experimental cognitive tests) will be required for testing the causal contribution of PMC to human cognition and subjective experience. Nonetheless, our findings suggest that some extant theories of PMC and DMN contribution to human awareness and subjective conscious states require cautious re-examination.
Collapse
Affiliation(s)
- Brett L Foster
- From the Laboratory of Behavioral and Cognitive Neuroscience (B.L.F., J.P.), Stanford Human Intracranial Cognitive Electrophysiology Program, Stanford University, CA; and Departments of Neurosurgery and Neuroscience (B.L.F.), Baylor College of Medicine, Houston, TX.
| | - Josef Parvizi
- From the Laboratory of Behavioral and Cognitive Neuroscience (B.L.F., J.P.), Stanford Human Intracranial Cognitive Electrophysiology Program, Stanford University, CA; and Departments of Neurosurgery and Neuroscience (B.L.F.), Baylor College of Medicine, Houston, TX.
| |
Collapse
|
22
|
Abstract
For a long time, although the functional anatomy of human cortex has extensively been studied, subcortical white matter tracts have received little consideration. Recent advances in tractography have opened the door to a non-invasive investigation of the subcortical fibers in vivo. However, this method cannot study directly the function of the bundles. Interestingly, for the first time in the history of cognitive neurosciences, direct axonal electrostimulation (DES) mapping of the neural pathways offers the unique opportunity to investigate the function of the connectomal anatomy. Indeed, this technique is able to perform real-time anatomo-functional correlations in awake patients who undergo brain surgery, especially at the level of the subcortical fibers. Here, the aim is to review original data issued from DES of myelinated tracts in adults, with regard to the functional connectivity mediating the sensorimotor, visuo-spatial, language, cognitive and emotional functions, as well as the interactions between these different sub-networks, leading ultimately to explore consciousness. Therefore, axonal stimulation is a valuable tool in the field of connectomics, that is, the map of neural connections, in order to switch from the traditional localizationist view of brain processing to a networking model in which cerebral functions are underpinned by the dynamic interactions of large-scale distributed and parallel sub-circuits. Such connectomal account should integrate the anatomic constraint represented by the subcortical fascicles. Indeed, post-lesional neuroplasticity is possible only on the condition that the white matter fibers are preserved, to allow communication and temporal synchronization among delocalized inter-connected networks.
Collapse
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295 Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1051 Laboratory, Team "Brain Plasticity, Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 34091 Montpellier, France
| |
Collapse
|