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. 2017 Feb 14;88(7):701-705.
doi: 10.1212/WNL.0000000000003613. Epub 2017 Jan 13.

Amygdala and hippocampus are symptomatogenic zones for central apneic seizures

Nuria Lacuey  1 , Bilal Zonjy  2 , Luisa Londono  2 , Samden D Lhatoo  2
Affiliations

Amygdala and hippocampus are symptomatogenic zones for central apneic seizures

Nuria Lacuey et al. Neurology. .

Abstract

Objective: To identify limbic sites of respiratory control in the human brain, and by extension, the symptomatogenic zone for central apnea.

Methods: We used direct stimulation of anatomically, precisely placed stereotactic EEG electrodes to analyze breathing responses. We prospectively studied 3 patients who were explored with stereotactically implanted depth electrodes. The amygdala and hippocampus, as well as extralimbic sites (orbitofrontal, temporal tip, and temporal neocortex), were investigated.

Results: Individual stimulation of the amygdala and hippocampal head consistently elicited central apnea in the expiratory phase, as did exquisitely focal hippocampal seizures.

Conclusions: These findings confirm that hippocampus and amygdala are limbic breathing control sites in humans, as well as the symptomatogenic zone for central apneic seizures.

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Figures

Figure 1
Figure 1. Apnea after hippocampus and amygdala stimulation
(A) Hippocampus head stimulation at intensities of 3 and 4 mA induced instant central apnea in patient 2. Apnea periods ended before stimulation was discontinued. (C) Apnea with 3 mA intensity stimulation of the hippocampus head in patient 2. (B, D) Stimulation in patient 2 at 6, 7, and 8 mA current intensities induced immediate change in respiratory rhythm. Central apnea was elicited at 10 mA current intensity in the same patient.
Figure 2
Figure 2. Apnea induced by amygdala stimulation and hippocampal seizure
Amygdala stimulation induced an immediate apnea in patient 1. Three seconds after apnea onset, a hippocampal seizure was seen. Breathing resumed when the seizure ended in the hippocampus and amygdala, but continued in the orbitofrontal cortex for a few seconds.
See this image and copyright information in PMC

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