Amygdala stimulation-induced apnea is attention and nasal-breathing dependent

Abstract

Objective:

Evidence suggests disordered breathing is critically involved in Sudden unexplained death in epilepsy (SUDEP). To that end, evaluating structures that are activated by seizures and can activate brain regions that produce cardiorespiratory changes can further our understanding of the pathophysiology of SUDEP. Prior preclinical studies have shown that electrical stimulation of the human amygdala induces apnea, suggesting a role for the amygdala in controlling respiration. In this study, we aimed to both confirm these findings in a larger group of patients with intractable temporal lobe epilepsy (TLE) and also further explore the anatomical and cognitive properties of this effect.

Methods:

Seven surgical TLE patients had depth electrodes implanted in the amygdala that were used to deliver electrical stimulation during functional mapping prior to resection. Real-time respiratory monitoring was performed in each patient to confirm apnea.

Results:

Our data confirm that amygdala stimulation reliably induces apnea (occurring in all seven patients) and further suggest that apnea can be overcome by instructing the patient to inhale, and can be prevented entirely by breathing through the mouth prior to electrical stimulation. Finally, stimulation induced apnea occurred only when stimulating the medial most amygdalar contacts located in the central nucleus.

Interpretation:

These findings confirm a functional connection between the amygdala and respiratory control in humans. Moreover, they suggest specific amygdalar nuclei may be critical in mediating this effect and that attentional state is critical to apnea mediated by amygdala activation - perhaps alluding to future development of strategies for the prevention of SUDEP. This article is protected by copyright. All rights reserved.

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