Cingulum stimulation enhances positive affect and anxiolysis to facilitate awake craniotomy
Kelly R Bijanki, Joseph R Manns, Cory S Inman, Ki Sueng Choi, Sahar Harati, Nigel P Pedersen, Daniel L Drane, Allison C Waters, Rebecca E Fasano, Helen S Mayberg, Jon T Willie, Kelly R Bijanki, Joseph R Manns, Cory S Inman, Ki Sueng Choi, Sahar Harati, Nigel P Pedersen, Daniel L Drane, Allison C Waters, Rebecca E Fasano, Helen S Mayberg, Jon T Willie
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.
Keywords: Neuroimaging; Neurological disorders; Neuroscience; Psychiatric diseases; Therapeutics.
Conflict of interest statement
Conflict of interest: KRB, JTW, NPP, and CSI are named inventors on a patent filing based on the work described herein (US Patent Application no. 16121599 [pending]: A method of electrically stimulating the dorsal anterior cingulum bundle to reduce anxiety, reduce pain, facilitate cognitive performance, and elicit spontaneous laughter, smiling, and euphoria). HSM receives fees from the licensing of intellectual property to St. Jude Medical Inc.; DLD receives grant funding from Medtronic Inc. and honoraria from NeuroPace Inc.; and JTW serves as a consultant for Medtronic Inc., MRI Interventions Inc., and NeuroPace Inc.
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Source: PubMed