Crying with depressed affect induced by electrical stimulation of the anterior insula: A stereo EEG case study

Direct stimulation of anterior insula and ventromedial prefrontal cortex disrupts economic choices

“…This results extends to humans previous findings from mice showing distinct areas within the insula controlling approach vs. avoidance behavior (Peng et al, 2015;Wang et al, 2018). Our findings also bridges with stimulation studies in non-human primates where stimulation of the ventral aIns reduced approach behaviors in appetitive contexts (Saga et al, 2019) and was associated with negative behaviors such as disgust (Caruana et al, 2011;Jezzini et al, 2012;Krolak-Salmon et al, 2003) or depression (Singh et al, 2021). Conversely, iES on the dorsal aIns has been more commonly associated with positive behaviors such as ingestion in monkeys (Jezzini et al, 2012) or even ecstatic feelings in rare case studies in humans (Bartolomei et al, 2019;Nencha et al, 2022;Picard et al, 2013).…”

“…To address these challenges, we conducted an experiment using intracranial electrical stimulation (iES) over human cortex to determine whether iES can disrupt choice behavior and also confidence judgments using a previously validated accept/reject task (Cecchi et al, 2022; Vinckier et al, 2018). Previous research has indicated that iES of the ventral aIns elicits disgust behavior or depressed affect (Caruana et al, 2011; Jezzini et al, 2012; Krolak-Salmon et al, 2003; Singh et al, 2021), whereas iES of the dorsal aIns elicits overwhelming ecstatic sensations or ingestive behavior, such as chewing and swallowing (Bartolomei et al, 2019; Jezzini et al, 2012; Nencha et al, 2022; Picard et al, 2013). Expanding on this evidence, we posit that harnessing the high spatial resolution of the iES will allow us to uncover functional circuits causally related to choice behavior.…”

Seizure semiology: ILAE glossary of terms and their significance

“…Ictal depression or sadness has been reported by 1% of patients with focal epilepsy arising from the temporal lobe [213, 221] (rarely during electrical cortical stimulation). They can also occur in seizures arising from the mesial temporal region [120], orbito‐frontal cortex [196], and the anterior insula in a single patient during electrical stimulation studies [228]. Seizures associated with sadness often accompany seizures with laughing in the setting of a hypothalamic hamartoma.…”

“…Sadness during seizures reflects the condition or quality of feeling sad or being unhappy and encompassing a feeling or showing sorrow. The lateralization is ill-defined and uncertain though the left hemisphere has demonstrated symptoms of sadness [120,196,228]. Ictal depression or sadness has been reported by 1% of patients with focal epilepsy arising from the temporal lobe [213,221] (rarely during electrical cortical stimulation).…”