Reduced Perception of Dyspnea and Pain after Right Insular Cortex Lesions

Schön, Daniela; Rosenkranz, Michael; Regelsberger, Jan; Dahme, Bernhard; Büchel, Christian; Leupoldt, Andreas von

doi:10.1164/rccm.200805-731oc

Cited by 79 publications

(45 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, activity in the anterior insula has been shown to predict the subjective perception of sensory stimulation, rather than the objective intensity of the stimulus [37], [38]. Lesions to this area tend to disrupt the unpleasantness associated with sensory experience, but not the perception of intensity [39]. In our dataset, increased activity in the anterior insula was seen selectively in response to disease-relevant cognitive stimuli prior to the development of a late-phase response.…”

Section: Discussionmentioning

confidence: 63%

Are There Neurophenotypes for Asthma? Functional Brain Imaging of the Interaction between Emotion and Inflammation in Asthma

et al. 2012

View full text Add to dashboard Cite

BackgroundAsthma is a chronic inflammatory disease noteworthy for its vulnerability to stress and emotion-induced symptom intensification. The fact that psychological stress and mood and anxiety disorders appear to increase expression of asthma symptoms suggests that neural signaling between the brain and lung at least partially modulates the inflammatory response and lung function. However, the precise nature of the neural pathways implicated in modulating asthma symptoms is unknown. Moreover, the extent to which variations in neural signaling predict different phenotypes of disease expression has not been studied.Methods and ResultsWe used functional magnetic resonance imaging to measure neural signals in response to asthma-specific emotional cues, following allergen exposure, in asthmatics with a dual response to allergen challenge (significant inflammation), asthmatics with only an immediate response (minimal inflammation), and healthy controls. The anterior insular cortex was differentially activated by asthma-relevant cues, compared to general negative cues, during the development of the late phase of the dual response in asthmatics. Moreover, the degree of this differential activation predicted changes in airway inflammation.ConclusionsThese findings indicate that neurophenotypes for asthma may be identifiable by neural reactivity of brain circuits known to be involved in processing emotional information. Those with greater activation in the anterior insula, in response to asthma-relevant psychological stimuli, exhibit greater inflammatory signals in the lung and increased severity of disease and may reflect a subset of asthmatics most vulnerable to the development of psychopathology. This approach offers an entirely new target for potential therapeutic intervention in asthma.

show abstract

Section: Discussionmentioning

confidence: 63%

Are There Neurophenotypes for Asthma? Functional Brain Imaging of the Interaction between Emotion and Inflammation in Asthma

et al. 2012

View full text Add to dashboard Cite

show abstract

“…13, 14 Neural integration occurs in cortico-limbic regions of the brain, which are influenced by thoughts and emotions, further modulating breathlessness perception. 11, 15 …”

Section: Understanding the Complexitymentioning

confidence: 99%

The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease

Spathis

Booth

Moffat

et al. 2017

npj Prim Care Resp Med

144

111

View full text Add to dashboard Cite

Refractory breathlessness is a highly prevalent and distressing symptom in advanced chronic respiratory disease. Its intensity is not reliably predicted by the severity of lung pathology, with unhelpful emotions and behaviours inadvertently exacerbating and perpetuating the problem. Improved symptom management is possible if clinicians choose appropriate non-pharmacological approaches, but these require engagement and commitment from both patients and clinicians. The Breathing Thinking Functioning clinical model is a proposal, developed from current evidence, that has the potential to facilitate effective symptom control, by providing a rationale and focus for treatment.

show abstract

“…At early stages of COPD, dyspnea usually develops during physical activities and exercise, whereas at later stages of the disease, it is already present at rest and is caused by hyperinflation of the lungs (i.e., an increase of end-expiratory lung volume due to airflow limitation), weakened respiratory muscles, or insufficiencies in gas exchange. The perception of dyspnea involves sensory and emotional aspects [7–10], which are presumably controlled by distinct brain areas [11–16], but respective neuroimaging data are currently not available in patients with COPD. In particular, the emotional aspects of perceived dyspnea seem to be closely linked to psychosocial factors and disease-related behavior in the everyday life of patients [8, 17–19].…”

Section: Definition Epidemiology and Pathophysiology Of Copdmentioning

confidence: 99%

Behavioral Medicine Approaches to Chronic Obstructive Pulmonary Disease

et al. 2012

Self Cite

View full text Add to dashboard Cite

Background Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease and associated with considerable individual and socioeconomic burden. Recent research started examining the role of psychosocial factors for course and management of the disease. Purpose This review provides an overview on recent findings on psychosocial factors and behavioral medicine approaches in COPD. Results Research has identified several important psychosocial factors and effective behavioral medicine interventions in COPD. However, there is considerable need for future research in this field. Conclusions Although beneficial effects of some behavioral medicine interventions have been demonstrated in COPD, future research efforts are necessary to study the effects of distinct components of these interventions, to thoroughly examine promising but yet not sufficiently proven interventions, and to develop new creative interventions.

show abstract

Reduced Perception of Dyspnea and Pain after Right Insular Cortex Lesions

Abstract: The results suggest that lesions of the right insular cortex are associated with reduced sensitivity for the perception of dyspnea and pain, in particular for their perceived unpleasantness. This underlines the importance of the insular cortex for the perception of both sensations.

Cited by 79 publications

References 48 publications

Are There Neurophenotypes for Asthma? Functional Brain Imaging of the Interaction between Emotion and Inflammation in Asthma

Are There Neurophenotypes for Asthma? Functional Brain Imaging of the Interaction between Emotion and Inflammation in Asthma

The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease

Behavioral Medicine Approaches to Chronic Obstructive Pulmonary Disease

Contact Info

Product

Resources

About