Hyperventilation-induced reduction in cerebral blood flow: assessment by positron emission tomography

Decreased CO2 saturation during circular breathwork supports emergence of altered states of consciousness

Altered states of consciousness (ASCs), induced e.g. during psychedelic-assisted therapy, show potential to treat prevalent mental health disorders like depression and posttraumatic stress disorder. However, access to such treatments is restricted by legal, medical, and financial barriers. Circular breathwork may present a non-pharmacological and hence more accessible alternative to engage similar therapeutic processes. Scientific studies of breathwork are only just emerging and its physiological and psychological mechanisms are largely unknown. Here, we track physiological and experiential dynamics throughout a breathwork session, comparing two forms of breathwork: Holotropic and Conscious-Connected breathwork. We show that a reduction in end-tidal CO2 pressure due to deliberate hyperventilation is significantly correlated to ASC onset (r = -0.46; p < 0.001). Based on standard questionnaires (MEQ-30 and 11-DASC), the ASCs evoked by breathwork resembled those produced by psychedelics across several experiential domains such as ego dissolution, and their depth predicted psychological and physiological follow-on effects, including improved well-being and reduced depressive symptoms. Further analysis showed that different breathwork approaches produced highly similar outcomes. Our findings identify physiological boundary conditions for ASCs to arise in a non-pharmacological context, shedding light on the functional mechanisms of breathwork as well as its potential as a psychotherapeutic tool.

Variability of physiological brain perfusion in healthy subjects - A systematic review of modifiers. Considerations for multi-center ASL studies

Quantitative measurements of brain perfusion are influenced by perfusion-modifiers. Standardization of measurement conditions and correction for important modifiers is essential to improve accuracy and to facilitate the interpretation of perfusion-derived parameters. An extensive literature search was carried out for factors influencing quantitative measurements of perfusion in the human brain unrelated to medication use. A total of 58 perfusion modifiers were categorized into four groups. Several factors (e.g., caffeine, aging, and blood gases) were found to induce a considerable effect on brain perfusion that was consistent across different studies; for other factors, the modifying effect was found to be debatable, due to contradictory results or lack of evidence. Using the results of this review, we propose a standard operating procedure, based on practices already implemented in several research centers. Also, a theory of 'deep MRI physiotyping' is inferred from the combined knowledge of factors influencing brain perfusion as a strategy to reduce variance by taking both personal information and the presence or absence of perfusion modifiers into account. We hypothesize that this will allow to personalize the concept of normality, as well as to reach more rigorous and earlier diagnoses of brain disorders.

[Neurotheology: neurobiological models of religious experience]

Religions are evolutionary selected social and cultural phenomena. They represent today belief and normative systems on which the main parts of our culture are based. For a long time religions have been seen as mainly originating from a spectrum of religious experiences. These include a broad spectrum of experiences and are astonishingly widespread in the population. The most consistent and transculturally uniform religious experiences are the mystical experiences. Only these (and the prayer experience) have factually been researched in detail neurobiologically. This article presents a review of empirical results and hypothetical approaches to explain mystical religious experiences neurobiologically. Some of the explanatory hypotheses possess logical evidence, some are even supported by neurobiological studies, but all of them have their pitfalls and are at best partially consistent. One important insight from the evidence reviewed here is that there may be a whole array of different neurophysiological conditions which may result in the same core religious mystical experiences.

Ultrasonographic assessment of global cerebral blood volume in healthy adults

The authors describe a new ultrasonographic method for analysis of global cerebral blood volume (CBV) and its application under controlled hyperventilation. CBV was determined as the product of global cerebral blood flow volume (CBF) and global cerebral circulation time. CBF was measured by duplex sonography and calculated as the sum of flow volumes in both internal carotid arteries and vertebral arteries. Extracranial Doppler assessed cerebral circulation time by determining the time interval of echo-contrast bolus arrival between internal carotid artery and contralateral internal jugular vein. Forty-four healthy volunteers (mean age 45 +/- 19 years, range 20-79 years) were studied. Mean CBV was 77 +/- 13 mL. CBV did not correlate with age, end-tidal carbon dioxide level, heart rate, or blood pressure. Hypocapnia was induced in 10 subjects by controlled hyperventilation. Mean reduction of end-tidal carbon dioxide values by 9 +/- 1 mm Hg led to a significant increase in cerebral circulation time (6.1 +/- 0.9 to 8.4 +/- 1.1 second, P < 0.0001) and a significant CBF decrease (742 +/- 85 to 526 +/- 77 mL/min, P < 0.0001), whereas CBV remained unchanged (75 +/- 6 to 73 +/- 10 mL).

On the function of groaning and hyperventilation during sexual intercourse: intensification of sexual experience by altering brain metabolism through hypocapnia

Sexual arousal is accompanied by some typical physiological reaction patterns. Another typical feature of sexual intercourse is involuntary sound production implying in its more intense forms acceleration of breathing (hyperventilation). Up to now no study examined spCO2 during intense sexual intercourse, but there is evidence that some degree of hyperventilation with its physiological consequences may often be induced during sexual intercourse. This article discusses implications of hyperventilation during sexual intercourse for alterations of consciousness and subjective experience in the light of recent studies of brain metabolic changes during states of hyperventilation. Groaning and hyperventilation are interpreted in this context as a psychophysiological mechanism to deepen states of sexual trance.

Interdependence of regional and global cerebral blood flow during visual stimulation: an O-15-butanol positron emission tomography study

The authors investigated the influence of variations in global cerebral blood flow (gCBF) on regional flow changes during visual stimulation. Global flow was varied using different end-expiratory CO2 values (PETCO2) between 20 and 70 mm Hg. Visual stimulation was performed with a red LED-array flashing at 8 Hz. Blood flow was measured with 0-15-butanol, continuous arterial blood sampling, and positron emission tomography (PET). Global flow changes surpassed the published values of O-15-H2O studies, better fitting the results of the inert gas technique (gCBF at 20, 40, and 70 mm Hg PETCO2 +/- SD was 31 +/- 4, 48 +/- 13, and 160 +/- 50 mL 100 g(-1) min(-1), respectively). The relation between PETCO2 and CBF in the current study was best described by an exponential rather than a linear function. At low PETCO2, the activation-induced flow changes are moderately damped, whereas at high PETCO2, they are nearly lost (deltaCBF (+/-SD): 52% +/- 25%, 68% +/- 22%, 16% +/- 25% at PETCO2 = 20, 40, 70 mm Hg, respectively).

Ictal and interictal SPECT findings in childhood absence epilepsy

The purpose of this study was to investigate the informative value of single photon emission tomography (SPECT) in relation to the pathophysiological functioning of the brain during absence seizures and the origin of ictal discharges in idiopathic generalized epilepsies (IGEs). Six patients with childhood absence epilepsy (CAE) were selected for the study and two consecutive SPECT sessions were performed concomitant with EEG recordings revealing normal results and during hyperventilation (HV) studies where the ictal discharges were induced either alone or accompanied by clinical absence seizures. All six patients had ictal discharges in their EEGs during HV and two of them also had clinical absences. SPECT findings during HV revealed an overall increase in the cerebral blood flow (CBF) with significantly higher values as compared to the baseline data. There was no indication for any focal origin in either the interictal or the ictal SPECT findings. Results of the study were supportive for the concept of subcortical origin for the absence seizures and they were also promising for the diagnostic value of ictal SPECT in epileptic cases with undetermined origin as to whether they were localization-related or generalized.

Correlation between cerebral perfusion and hyperventilation enhanced focal spiking activity

Single photon emission computed tomography (SPECT) has frequently been used to investigate cerebral brain perfusion (CBP) occurring ictally and inter-ictally in epileptic patients. Several studies have addressed the multimodal analysis of the modifications occurring in cerebral areas involved in seizure activity, by correlating SPECT with electroencephalografic (EEG) recordings during ictal and inter-ictal epileptiform lateralized discharges (IELDs). Although these studies have yielded interesting results, variations in regional CBP (rCBP) observed during ictal events are difficult to interpret since the areas of altered rCBP might reflect not only events restricted to the epileptogenic focus, but also large fluctuations determined by seizure spread. Inter-ictal rCBP correlates with the area generating the local EEG epileptogenic activity in a limited percentage of studies. Hyperventilation (HPV) represents a well established EEG activation procedure aimed at enhancing epileptiform discharges. Since HPV-enhanced IELDs may help analyze the CBP pathophysiology in inter-ictal epilepsy, in the present study we investigate this specific aspect co-registering EEG with SPECT in subjects affected by partial epilepsy responding to HPV with IELD enhancement without seizure precipitation. This study suggests a correlation between localized increase in rCBP and HPV-induced IELDs and provides a tool to discuss uncommon aspects of the physiology of rCBP during the inter-ictal state in the epileptogenic areas.

Fast and slow components of cerebral blood flow response to step decreases in end-tidal PCO2 in humans

This study examined the dynamics of the middle cerebral artery (MCA) blood flow response to hypocapnia in humans (n = 6) by using transcranial Doppler ultrasound. In a control protocol, end-tidal PCO2 (PETCO2) was held near eucapnia (1.5 Torr above resting) for 40 min. In a hypocapnic protocol, PETCO2 was held near eucapnia for 10 min, then at 15 Torr below eucapnia for 20 min, and then near eucapnia for 10 min. During both protocols, subjects hyperventilated throughout and PETCO2 and end-tidal PO2 were controlled by using the dynamic end-tidal forcing technique. Beat-by-beat values were calculated for the intensity-weighted mean velocity (VIWM), signal power (P), and their instantaneous product (P.VIWM). A simple model consisting of a delay, gain terms, time constants (tauf,on, tauf, off) and baseline levels of flow for the on- and off-transients, and a gain term (gs) and time constant (taus) for a second slower component was fitted to the hypocapnic protocol. The cerebral blood flow response to hypocapnia was characterized by a significant (P < 0.001) slow progressive adaptation in P.VIWM, with gs = 1.26 %/Torr and taus = 427 s, that persisted throughout the hypocapnic period. Finally, the responses at the onset and relief of hypocapnia were asymmetric (P < 0.001), with tauf,on (6.8 s) faster than tauf,off (14.3 s).