JLE

Epileptic Disorders

MENU

Ictal fear during parietal seizures Volume 23, issue 5, October 2021

TEST YOURSELF

(1) Which brain structures are involved in fear and its regulation?

 

(2) What are the main aspects of epileptic seizures with fear?

 

(3) What is the incidence of fear in parietal seizures?

 

 

 

 

 

 

See answers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answers

(1) A variety of brain structures are implicated in the expression and regulation of fear. It has long been known that amygdala plays a central role both in the processing of emotionally relevant stimuli and in mediating the emotional responses, in particular those of fear and anxiety. The prefrontal and orbitofrontal cortices exhibit top-down control over the emotional processing and emergence of behavioural responses.

Phan KL, Wager T, Taylor SF, Liberzon I. Functional neuroanatomy of emotion: a meta-analysis of emotion activation studies in PET and fMRI. Neuroimage 2002; 16(2) :331-48.

 

The role of the parietal cortex is not well known. The parietal lobe participates in recognition of facial expressions together with the occipitotemporal cortex, amygdala, orbitofrontal cortex and basal ganglia. A study of patients with focal brain lesions revealed that lesions in the right somatosensory-related cortices were associated with impaired recognition of facial expressions.

Adolphs R, Damasio H, Tranel D, Cooper G, Damasio AR. A role for somatosensory cortices in the visual recognition of emotion as revealed by three-dimensional lesion mapping. J Neurosci 2000; 20(7): 2683-90

 

(2) Fear is one of the most common auras reported in mesial temporal lobe seizures. In such seizures, patients often experience a fearful sensation or anxiety. More complex patterns of fearful sensation and behavioural expressions of fear may be observed in temporo-frontal seizures. In mesial ventromedian prefrontal or in temporo-frontal seizures, the clinical presentation may be dominated by dramatic manifestation of intense fear or a panic behaviour can be observed.

Biraben A, Taussig D, Thomas P, Even C, Vignal J, Scarabin J, et al. Fear as the main feature of epileptic seizures. J Neurol Neurosurg Psychiatry 2001; 70: 186-91.

Bonini F, McGonigal A, Trebuchon A, Gavaret M, Bartolomei F, Giusiano B, et al. Frontal lobe seizures: from clinical semiology to localization. Epilepsia 2014; 55(2): 264-77.

Bartolomei F, Trebuchon A, Gavaret M, Regis J, Wendling F, Chauvel P. Acute alteration of emotional behaviour in epileptic seizures is related to transient desynchrony in emotion-regulation networks. Clin Neurophysiol 2005; 116(10): 2473-9.

 

(3) So far, very few patients have been reported with fear as an ictal manifestation of parietal lobe seizures, documented with intracerebral recordings.

Alemayehu S, Bergey GK, Barry E, Krumholz A, Wolf A, Fleming CP, et al. Panic attacks as ictal manifestations of parietal lobe seizures. Epilepsia 1995; 36(8): 824-30.

In an SEEG study from our group, ictal fear was found in 17% of cases. Propagation to the amygdala was observed in only one case.

Bartolomei F, Gavaret M, Hewett R, Valton L, Aubert S, Regis J, et al. Neural networks underlying parietal lobe seizures: a quantified study from intracerebral recordings. Epilepsy Res 2011; 93(2-3): 164-76

 

 

 

 

 

 

 

 Back to questions