Induction of panic attack by stimulation of the ventromedial hypothalamus

Abstract

Panic attacks are sudden debilitating attacks of intense distress often accompanied by physical symptoms such as shortness of breath and heart palpitations. Numerous brain regions, hormones, and neurotransmitter systems are putatively involved, but the etiology and neurocircuitry of panic attacks is far from established. One particular brain region of interest is the ventromedial hypothalamus (VMH). In cats and rats, electrical stimulation delivered to the VMH has been shown to evoke an emotional "panic attack-like" escape behavior, and in humans, stimulation targeting nuclei just posterior or anterior to the VMH has reportedly induced panic attacks. The authors report findings obtained in an awake patient undergoing bilateral implantation of deep brain stimulation electrodes into the hypothalamus that strongly implicates the VMH as being critically involved in the genesis of panic attacks. First, as the stimulating electrode progressed deeper into the VMH, the intensity of stimulation required to evoke an attack systematically decreased; second, while stimulation of the VMH in either hemisphere evoked panic, stimulation that appeared to be in the center of the VMH was more potent. Thus, this evidence supports the role of the VMH in the induction of panic attacks purported by animal studies.

Reflections on a footnote: implications for the study of emotions in animals

“…Knowing the fear circuit predominantly affected could help to develop psychotherapeutic and pharmacological interventions which will be more specific than interventions based on theoretical views that conceptualize fear as a unitary psychological construct. In humans, there is evidence that electrical stimulation of the dorsal part of the ventromedial nucleus of the hypothalamus (dmVMH) elicits a sensation of panic and impending death (Wilent, 2010) and that stimulation of the dorsolateral PAG causes a feeling of uncertainty and being chased by someone (Amano et al, 1982). Perhaps underlying panic attacks, which cause so much suffering to many people, is a circuit of predator fear.…”

The hypothalamus at the crossroads of psychopathology and neurosurgery

“…29 Hypothalamic DBS has been considered a possible therapeutic option for refractory obesity, panic disorder, and aggressive or disruptive behaviors in patients with mental impairment or brain damage. 31,113 For some of those conditions, encouraging results are becoming available in the literature.…”

“…9,75 In 2010, Wilent et al reported panic attacks in response to stimulation of the VMH in a 50-year-old woman undergoing bilateral implantation of DBS leads into the lateral hypothalamus for the treatment of obesity. 113 The patient had a dramatic increase in anxiety, blood pressure, and heart rate, accompanied by hyperventilation and nausea. While stimulation of this area in either hemisphere led to the aforementioned response, stimulation appeared to be more effective at the center of the VMH.…”

Deep brain stimulation for obesity: past, present, and future targets

“…Confirming that stimulation of the VMH leads to undesirable effects, Wilent et al reported that DBS induced panic attacks in a graded manner during HFS of the VMH, demonstrating that its stimulation causes adverse psychogenic manifestations. 105 Since publication of these results, no additional trials involving DBS of the VMH have been reported.…”