Altered sense of self during seizures in the posteromedial cortex

Josef Parvizi*, Rodrigo M. Braga, Aaron Kucyi, Mike J. Veit, Pedro Pinheiro-Chagas, Claire Perry, Clara Sava-Segal, Michael Zeineh, Eric Klaas van Staalduinen, Jaimie M. Henderson, Matthew Markert

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

The posteromedial cortex (PMC) is known to be a core node of the default mode network. Given its anatomical location and blood supply pattern, the effects of targeted disruption of this part of the brain are largely unknown. Here, we report a rare case of a patient (S19_137) with confirmed seizures originating within the PMC. Intracranial recordings confirmed the onset of seizures in the right dorsal posterior cingulate cortex, adjacent to the marginal sulcus, likely corresponding to Brodmann area 31. Upon the onset of seizures, the patient reported a reproducible sense of self-dissociation—a condition he described as a distorted awareness of the position of his body in space and feeling as if he had temporarily become an outside observer to his own thoughts, his “me” having become a separate entity that was listening to different parts of his brain speak to each other. Importantly, 50-Hz electrical stimulation of the seizure zone and a homotopical region within the contralateral PMC induced a subjectively similar state, reproducibly. We supplement our clinical findings with the definition of the patient’s network anatomy at sites of interest using cortico-cortical–evoked potentials, experimental and resting-state electrophysiological connectivity, and individual-level functional imaging. This rare case of patient S19_137 highlights the potential causal importance of the PMC for integrating self-referential information and provides clues for future mechanistic studies of self-dissociation in neuropsychiatric populations.

Original languageEnglish (US)
Article numbere2100522118
JournalProceedings of the National Academy of Sciences of the United States of America
Volume118
Issue number29
DOIs
StatePublished - Jul 20 2021
Externally publishedYes

Keywords

  • Self-dissociation | epilepsy | default mode network | posterior cingulate | Brodmann area 31

ASJC Scopus subject areas

  • General

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