Abstract
Objectives
The insula is a brain area involved in the modulation of autonomic responses. Previous
studies have focused mainly on its heart rate regulatory function, but its role in
vascular control is not well defined. Ictal/postictal blood pressure (BP) fluctuations
may have a role in the pathogenesis of sudden unexpected death in epilepsy. This study
aims to characterize the insular influence on vascular regulation through direct high-frequency
electrical stimulation (E-stim) of different insular regions during stereo-electroencephalographic
studies.
Materials and Methods
An observational, prospective study was conducted, involving people with epilepsy
who underwent E-stim of depth electrodes implanted in the insular cortex. Patients
with anatomical or electrophysiological insular abnormalities, E-stim producing after
discharges, or any elicited symptoms were excluded. Variations of BP and systemic
vascular resistance (SVR) during the insular stimuli were analyzed, comparing them
with those observed during E-stim of control contacts implanted in cortical noneloquent
regions and sham stimulations.
Results
Fourteen patients were included, five implanted in the right insula and nine in the
left. We analyzed 14 stimulations in the right insula, 18 in the left insula, 18 in
control electrodes, and 13 sham stimulations. Most right insular responses were hypertensive,
whereas most left ones were hypotensive. E-stim of the right insula produced a significant
BP and SVR increase, whereas the left insula induced a significant BP decrease without
SVR changes. The most remarkable changes were elicited in both posterior insulas,
although the magnitude of BP changes was generally low. Control and sham stimulations
did not induce BP or SVR changes.
Conclusion
Our findings on insular stimulation suggest an interhemispheric difference in its
vascular regulatory function, with a vasopressor effect of the right insula and a
vasodilator effect of the left one.
Keywords
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Comment
Article info
Publication history
Published online: January 20, 2023
Accepted:
December 28,
2022
Received in revised form:
December 8,
2022
Received:
October 2,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: The authors reported no funding sources.
Conflict of Interest: The authors reported no conflict of interest.
Identification
Copyright
© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
