Dataset Information

Cingulum stimulation enhances positive affect and anxiolysis to facilitate awake craniotomy.

ABSTRACT:

Background

Awake neurosurgery requires patients to converse and respond to visual or verbal prompts to identify and protect brain tissue supporting essential functions such as language, primary sensory modalities, and motor function. These procedures can be poorly tolerated because of patient anxiety, yet acute anxiolytic medications typically cause sedation and impair cortical function.

Methods

In this study, direct electrical stimulation of the left dorsal anterior cingulum bundle was discovered to reliably evoke positive affect and anxiolysis without sedation in a patient with epilepsy undergoing research testing during standard inpatient intracranial electrode monitoring. These effects were quantified using subjective and objective behavioral measures, and stimulation was found to evoke robust changes in local and distant neural activity.

Results

The index patient ultimately required an awake craniotomy procedure to confirm safe resection margins in the treatment of her epilepsy. During the procedure, cingulum bundle stimulation enhanced positive affect and reduced the patient's anxiety to the point that intravenous anesthetic/anxiolytic medications were discontinued and cognitive testing was completed. Behavioral responses were subsequently replicated in 2 patients with anatomically similar electrode placements localized to an approximately 1-cm span along the anterior dorsal cingulum bundle above genu of the corpus callosum.

Conclusions

The current study demonstrates a robust anxiolytic response to cingulum bundle stimulation in 3 patients with epilepsy.

Trial registration

The current study was not affiliated with any formal clinical trial.

Funding

This project was supported by the American Foundation for Suicide Prevention and the NIH.

SUBMITTER: Bijanki KR

PROVIDER: S-EPMC6391096 | biostudies-literature |

REPOSITORIES: biostudies-literature

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