Epilepsy and Ecstatic Experiences: The Role of the Insula

Abstract

Ecstatic epilepsy is a rare form of focal epilepsy in which the aura (beginning of the seizures) consists of a blissful state of mental clarity/feeling of certainty. Such a state has also been described as a “religious” or mystical experience. While this form of epilepsy has long been recognized as a temporal lobe epilepsy, we have accumulated evidence converging toward the location of the symptomatogenic zone in the dorsal anterior insula during the 10 last years. The neurocognitive hypothesis for the genesis of a mental clarity is the suppression of the interoceptive prediction errors and of the unexpected surprise associated with any incoming internal or external signal, usually processed by the dorsal anterior insula. This mimics a perfect prediction of the world and induces a feeling of certainty. The ecstatic epilepsy is thus an amazing model for the role of anterior insula in uncertainty and surprise.

Characteristics and Neural Correlates of Emotional Behavior during Prefrontal Seizures

“…Investigation of neural correlates of emotion, using electrophysiological and neuroanatomical methods, have mainly focused on fear‐related defensive behaviors. In animals, studies of conditioned fear responses 5 and fear extinction studies 6 demonstrate a spectrum of behaviors—flight, flight, and freeze—showing scalability 3 according to the proximity of the threat, which depend upon cortical and subcortical circuits, involving amygdala, hippocampus, and striatum (attention, action, and threat systems) and phylogenetically older circuits involving midbrain and medulla 8 . Distinction can be made between subjective (feeling, affective) and objective (behavioral) aspects of emotion, and it has been postulated that these may have different neural correlates 9 .…”

“…8 Distinction can be made between subjective (feeling, affective) and objective (behavioral) aspects of emotion, and it has been postulated that these may have different neural correlates. 9 Data on objective behavioral expressions of emotion predominantly come from animal (mainly nonprimate) models, 8,10 whereas human studies have used subjective and objective reports of emotion, using functional neuroimaging 11 or electrophysiological methods. 12 Epileptic seizures represent an interesting data source for studying emotional expression in humans.…”

“…12 Epileptic seizures represent an interesting data source for studying emotional expression in humans. Seizure semiology may include subjective feelings reported by the patient such as fear/anxiety, [5][6][7] sadness, pleasant, or ecstatic sensations, 5,8 and/or objective behavioral change observed during the seizure, most commonly defensive behavior, 6,[9][10][11][12][13] but also aggression, 14,15 laughter, 16 or crying. 13,16 Emotional phenomena may also be triggered during electrical brain stimulation studies in epileptic patients.…”

“…In animals, studies of conditioned fear responses 5 and fear extinction studies 6 demonstrate a spectrum of behaviorsflight, flight, and freeze-showing scalability 3 according to the proximity of the threat, which depend upon cortical and subcortical circuits, involving amygdala, hippocampus, and striatum (attention, action, and threat systems) and phylogenetically older circuits involving midbrain and medulla. 8 Distinction can be made between subjective (feeling, affective) and objective (behavioral) aspects of emotion, and it has been postulated that these may have different neural correlates. 9 Data on objective behavioral expressions of emotion predominantly come from animal (mainly nonprimate) models, 8,10 whereas human studies have used subjective and objective reports of emotion, using functional neuroimaging 11 or electrophysiological methods.…”

From distal to proximal to interactive: Behavioral and brain synchrony during attraction, courtship, and sexual interaction

“…These likely rival (or surpass) anything that could be achieved with exogenous compounds, or at least not safely, since endogenous mechanisms involve local release and natural clearance mechanisms. Further, it has been suggested that the moment of orgasm itself involves quasi-epileptiform dynamics in the form of explosive percolation through super-critical systems, potentially explaining some parallels between the neurophenomenology of orgasm and temporal lobe seizures with ecstatic auras (Asheim Hansen, & Brodtkorb, 2003;Arias, 2019;Chaton et al, 2018;Picard, Bossaerts, & Bartolomei, 2021) and related feelings of post-ictal relaxation, well-being, and spirituality (Devinsky & Lai, 2008;Picard & Craig, 2009). If these events happen in the context of another individual who is similarly altered, then bonding and potential co-mingling of various self-related processes may naturally arise.…”