13 February 2019

Joking through brain surgery? Seriously?

Neuroscientists found that stimulating a certain area of the brain can trigger laughter and good feelings in patients who must stay awake during brain surgery.

Brain surgery's pretty serious, but someday patients may laugh their way through it.

A young woman with epilepsy who was undergoing surgery at Emory University in Atlanta did just that, even cracking jokes during her procedure, according to a new study.

Involuntary urge to laugh

Neuroscientists at Emory School of Medicine found that stimulating a certain area of the brain can trigger laughter and good feelings in patients who must stay awake during brain surgery.

This particular patient was undergoing diagnostic monitoring for epileptic seizures. First, they found that electrical stimulation of a white matter tract in the brain called the cingulum bundle prompted immediate laughter, followed by a sense of calm and happiness.

"She reported an involuntary urge to laugh that began at the onset of stimulation and evolved into a pleasant, relaxed feeling over the course of a few seconds of stimulation," the researchers explained.

Surgeons then used the technique when she had awake brain surgery two days later.

This approach could be a "potentially transformative" way to calm some patients during awake brain surgery, even for those not especially anxious, the surgeons suggested.

Moderate baseline anxiety

In some cases, patients must remain awake and not sedated during brain surgery in order to monitor and protect critical brain functions. By talking with the patients, doctors can assess their language skills to detect any surgery-related problems.

But even "well-prepared patients may panic during awake surgery, which can be dangerous," study lead author Kelly Bijanki said in a university news release.

"This particular patient was especially prone to it because of moderate baseline anxiety," said Bijanki, an assistant professor of neurosurgery.

"And upon waking from global anaesthesia, she did indeed begin to panic. When we turned on her cingulum stimulation, she immediately reported feeling happy and relaxed, told jokes about her family, and was able to tolerate the awake procedure successfully," she continued.

The scientists said they confirmed the beneficial effects of electrical stimulation of the cingulum bundle in two other epilepsy patients undergoing diagnostic monitoring.

The study was published in the Journal of Clinical Investigation.

Chronic deep brain stimulation therapies

Cingulum bundle stimulation may also prove useful in surgery for brain tumours, according to the researchers.

"We could be surer of safe boundaries for removal of pathological tissue and preservation of tissue encoding critical human functions such as language, emotional, or sensory functions, which can't be evaluated with the patient sedated," Bijanki said.

"In addition, although substantial further study is necessary in this area, the cingulum bundle could become a new target for chronic deep brain stimulation therapies for anxiety, mood and pain disorders," Bijanki said.

The researchers supplied this video of the unidentified patient responding to the electrode stimulation:

Image credit: iStock




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