Electrical Self-stimulation of the Brain

8/3/2019 Electrical Self-stimulation of the Brain

1/7

ELECTR ICAL SELF-ST IM ULAT ION OF THE BRA IN IN 4 1

571

ROBERT C . H EATH , M .D .2 3

A t a sym po sium con cern ing dep th elec -t rode s tud ie s in an ima l s and m an in N ewO rlean s in 1952 , th e Tulan e investig ato rsd esc rib ed (and i l lu st rated with f i lms of pa -tien ts trea ted be tw een 1950-1 952 ) a p leas-urable re sp onse w ith stim u la tion of specif icreg ions of the brain (5 ) . The p lea su rab le re -sponse to s tim ula tio n o f som e deep reg ion sof the b ra in , f irs t obse rved w ith elec trica lst imu lat ion to the sep ta l reg ion , h as p rov eda c on si st en t f ind ing in con tin u ing s tu d ie s(6 ,7 , 12 ). S ince 1952 w e have reported variousaspects o f th e phenom enon in clud ing dem -onstra tion o f re lie f o f physical p a in by stim -u la tion to this pleasu re-y ie ld ing a rea of thebrain(11) .

W ith th e in trod uc tion o f in gen iou stechn iqu es fo r self-s tim u lation by O ld s(14 -17), th e n eed to d ep end larg ely uponverba l repo rts of the sub jec tive responsew as e lim ina ted and it w as possib le to s tu dyappa ren t rew ard and avers iv e areas of thebrain in an im a ls . Subjective d a ta, o f course,w ere lack ing in th e an im al stud ies .

During the las t few years the Tu lan eresea rch ers h av e incorpora ted and m od ifiedsom e anim a l in trac ran ial se lf-s tim ula tio n( ICSS ) meth o d s fo r hum an investiga tio n ,pe rm ittin g ex tensio n of the pleasurableph en om enon stu d ie s in m an . A n IC SS studyrecen tly p ub lished(3 ) was designed to ex -p lore hum an behavio r und e r s tric t labo -ra to ry condition s of the type character is t ic-a lly em ploy ed in an im al s tu d ie s . A studyhas also been describ ed in w hich a p atien t

1R ead a t th e 119 th an nua l m ee ting o f T heAmer i can P sy ch ia tric A sso ci ati on , St Louis , Mo. ,M ay 6-10 , 1963 .

A t th e tim e of presen ta tio n , a 16 mm . soun d filmw as s h own demonstrat ing th e effects of s t imula t ionby th e transis to rized p ortab le se lf-s tim u la to r to anum ber o f sp ec if ic reg ions o f th e b rain in Patien tsN o . B -7 an d N o . B -b . T he tw o sub jec ts w erein te rv iew ed to o b ta in sub jec tive d escr ip tio ns o fth e effec ts o f stim u latio n .S upported b y fun ds p ro v ided b y the Lou isianaS ta te D ep artm en t o f H osp ita ls .2D ep t. o f P sych ia try and N euro logy , Tu laneUnivers i ty Schoo l o f M ed icin e, N ew O rleans , L a .

3Char les J. Fontana , Electroencephalog raph icTechno log is t an d Esther Blount , R .N ., R esearchN urse , A ssis tan ts .

w as equ ipp ed w ith a sm a ll po rtab le se lf-s tim u la to r w ith 3 bu tto ns , p erm itting de liv -er y o f e lectr ical s tim u li o f fix ed pa ra me te rsto any one o f 3 bra in s ites(8 ). T he pri-mary m otiva tion in th ese s tu d ie s , as in a lldep th elec trod e stud ie s in m an at T u lan e,w as th era pe utic (5 ).

S tudy o f rew ard a reas in th e brain o fm an , inc lud ing us e of in duced rew ard fo rthe rapeu tic purposes , is ex tensiv e and com -p lex . T his presen ta tion w ill fo cu s on a de -sc r ip tion o f th e sub jec tive re spo nsesof tw o pa tien ts trea ted by the se lf-s tim u la -tion techn ique . T he ir reports prov id e in -f orma t ion concern ing th e reason s fo r re -peated IC SS -in fo rm a tio n th a t is no t avai l -ab le from an im a l stud ies .MATER IAL AN D M ETHO DS

Tw o pa tien ts w ere u sed in th e study .Pa tien t N o. B -7 , age 28 , w ith a d iagno sisof n arco lep sy and catap lexy , ha d fai led torespond to conventio na l treatm ents . H ehad e lectro des im p lan ted by th e m ethoddeve lop ed in our labo rato ry ( 1 , 2 ) in to 14predetermined b rain reg ion s and fix ed tor ema in in ex ac t position for pro longedstud y . T hese sm a ll s ilve r b a ll e lec trod es(m o st o f th ose used in th is s tudy co nsis tedof 3 lead s each sep ara ted by 2 mm .) w erep laced in to th e righ t an te rio r an d pos ter io rsep ta l reg ion , le ft an te rio r and po sterio rsep ta l reg ion , r igh t an te rio r hy po th alam u s,m id -lin e m esencepha lic tegm en tum , leftan te rio r and poste rio r h ippocam pu s, lef tanter ior an d poster io r cauda te nuc leusand over the r igh t f rontal co rtex , rig h tand le ft m id-tem pora l cortex , and le ft an-te rio r tem pora l cortex .

Pa tien t N o . B -10 , age 2 5 , a psy ch om o to repileptic with ep isod ic b rie f pe rio ds of im -pu lsive b eh av io r unco n tro lled w ith th eu sua l trea tm en ts , had 51 leads imp lan tedin to 17 b rain s ites : le ft and righ t cen tro -m edian , left cauda te nuc leu s , r igh t yen-tricle , le ft and rig h t h ippocam pus, m id -l ine m esencepha lic tegm en tum , le ft andr igh t sep ta l reg ion , left am ygda lo id nuc leu s ,left pa rao lfacto ry a rea , and ove r th e le ft


2/7

57 2 ELECTR ICA L SELF -ST IM ULA T ION OF THE BRA IN IN MA N [Decemberand righ t tem po ral co rtex , left and righ toccip ital co rtex , and le ft and r igh t fron ta lco rtex . Twenty- f our leads w ere o f stain lesss teel .003 in ch in d iam ete r coa ted w ith T ef-lo n ; 27 w ere the sm all s ilv er ba ll type elec-trode.4

IC SS stud ies w ere no t in itia ted un til am in im a l p eriod o f 6 m onth s fo llow ing op -eration, assu ring elim ina tion of an y var ia-b le s in tro duced by opera tiv e traum a, e.g. ,edem a , an esth e tic e ffec ts .

Stimuli w ere de liv ered from a sp ec ia llyconstructed transis to rized se lf-con ta inedun it5 w h ich w as w orn on th e p atien ts be lt.T h e un it g en e ra ted a pre -set tra in of b i-directional s tim u lu s p u lse s each t ime thato ne of the 3 contro l bu tton s w as d epressed .E ach bu tton d irec ted the pulse tra in to ad iffe ren t elec trod e pair perm itt ing the ope r-ator a pos sib le se lectio n o f cereb ral s ites .A m echan ical cou n te r w as cou p led to eachbutto n to reco rd the , to ta l n um ber ofst imu li d irec ted tow ard a g iven area . A nin te rna l tim er lim ited each pu lse tra in to0 .5 second for each dep ress io n , th erebyp roh ib iting th e ope ra to r from ob tain ingcon tin uou s stim u li m erely by keep ing th ebutto n depressed . A n add itio na l fea tu re ofthe unit p rov ided 3 sepa ra te lev el po ten -tiom e ters to g ive w ide -range contro l o fst imu li fo r each e lectro de pa ir.C ircu it d e ta ili. To min im ize the effec ts

o f dc polarization , a b i-d irection al pu lsew as chosen (F ig . 1 ). T h is pu lse per-m itted resto ra tion of the d c leve l to ze roa fte r each 1 .0 m illisecond st imu lus an dm ain tenan ce a t ze ro du ring the en tire deadt ime of 10 mill iseconds.

A silicon un ijunc tio n tim in g c ircu it gen -era ted th e b asic 10 m illisecond in te rva l.T he ou tpu t from th e un ijun c tio n tran sis to rw as gated off a fte r 0 .5 second opera tion bya diode ga te d riven from an R -G charg ingcircu it. W hen the d iod e ga te w as open , theurn jun ctio n tran sis to r g en era to r d ro ve tw ocom plem en tary on e-sho t m ultiv ib ra to rs op-era ted se ria lly , pe rm itting th e fal l ing edge

4 Sta in less steel array cons truc ted of N o . 31 6s ta in less steel wire , .003 inch in d iameter , withq ua d T eflo n-c oate d leads an d 6 con tac t po in ts2 mm . apart. E lec trod e designed and fabr ica tedby H enry A . Schry ver, 11 0 W . P ackard S t., F ortW ayne, Ind ian a.

5 Techn ica l A sso cia te s o f N ew O rleans.

F IG UR E 1C ircu it D iag ram fo r T ran s is to r ize d In tra cra n ia l Se l f -

s timulator

o f th e firs t to trig ge r th e second . T he tw om ultiv ib rato rs had equa l pe rio ds of 0 .5m illisecond . T he m ultiv ib rato r t iming cir -cuits sa tu rated com plem en ta ry o u tp u t tran -sis to rs w h ich fed v o ltage to the lo adthmugh iso lating capacito rs .

T he stim uli w ere m ono -po lar; th e in -d iffe ren t po le w as a p la te s trapped to thesub jec ts leg .

S tud ie s conduc ted on the tw o patientsd iffe red som ew ha t because of the rap eu ticconsiderations . For stu d ie s w ith Pa tien t N o .B -7 , th e na rco lep tic , the 3 bu tton s o f th eun it w ere a ttach ed to e lec trod es in th esep ta l reg ion , h ippocam pus, and m esen -cepha lic tegm en tum , and he w as free tos tim ula te any of th ese sites as he cho se .T he pa tien t w ore the stim u la to r fo r a pe -rio d of 17 week s . B efo re h e w as equippedwith th e un it, baseline d ata concern ing thetim e he sp en t sleep ing d uring an a rb itra ry6-hou r p erio d each day w ere ch a rted byspecified w ard pe rsonnel. T hese da ta w erelater com pared w ith s leep ing t ime f o l low-in g a tta ch me nt of the un it. T h is s tu dy w asb asica lly the rapeu tic ( trea tm en t re su lts w illbe presen ted e lsew here ) bu t f rom the ex -p e rim ental design w e w ere ab le to ob taincon side rab le sub jective da ta rega rd ing thee ffec ts o f IC SS to seve ral reg ions o f thebrain.

W ith Pa tien t N o. B -10 , th e p sy chom otorep ilep tic , a num ber of d ifferen t expe ri-m en tal d esig ns w ere em plo yed to in vesti-ga te th e e ffects o f IC SS . Fo r illu strativ epu rpo ses , th e re su lts o f one study are pre -sen ted he re in as b ackground for a desc rip -


3/7

F IG U RE 2C ompa ra tiv e S ite s , IC SS . F requency o f S tim ula tion toVa rio us In trac ra n ia l S ite s Expre ss ed In P e rcen tages In

P at ien t w ith N arco lep sy and Ca tap le xyIcss

C o mp a ra t iv e S i te s

tion of th e sub jective responses. In th e firs tpart of the stu dy a to ta l o f 17 differen tcereb ral reg ion s w ere s tim ula ted . T heyw ere se lec ted at random , th e un it d es ignpermit t ing 3 sites to be hooked up a t anyone tim e . E ach elec trod e w as m ade ava il-ab le to th e p atien t fo r s tim ula tio n for a S S S S Smin ima l period of 2 hours . V ariou s com -b ina tio ns of 3 site s w ere arrang ed . T he pur-pose in m aking stim ula tio n to d iffe ren tcombinat ions o f s ite s ava ilab le w as basedo n w el l-d oc um en te d an im a l stud ies whichind ica te th at rate o f s tim ula tio n a t a g ivensite w ill va ry som ew ha t depend ing uponthe site stim u la ted b efo reh and . D a ta a rep resen ted in te rm s of the h ourly stim u la -tio n to a g iven site as reco rded w ith th eau tom atic coun te r o f th e nu ll. A dd itio na lly ,the sam e site o f the brain was at tached tod ifferen t button s to d eterm ine if the pa -tien t w ou ld re la te a re spon se to a g ivenbu tton . H e repo rted , how ever, a consis ten tresponse to s tim ulation of a g iv en elec trod erega rd le ss of th e bu tto n to w h ich it w as a t-tached .

In th e second part of the study the 3si tes o f the b rain w h ich th e sub jec t hade lec ted to s tim ula te m ost frequen tly duringth e firs t part o f th e study w ere com paredove r a 6 -hour p eriod .

80.

60 S ep ta 40 ...,A , I1! ntum , / \ I !

20 \/ \ I i B#{149}7 (P&W.)\

I t 1 I IWeek s

la to r, he w as em ployed pa rt-tim e , w hilew earin g the un it , as an en terta in er in an igh t c lub .

T he pa tien ts na rco lepsy w as seve re. H ew ou ld m ove from an alert s ta te in to a d eeps leep in th e m atte r of a second . R ecogn iz-in g th at bu tton p ress ing prom p tly aw ak -en ed h im , fellow pa tien ts and fr iends oc -casion a lly re sorted to pu sh ing th e buttonif h e fe ll as leep so rap id ly th a t he w as un-ab le to s tim u la te h im se lf.

T h e pa tien t, in exp la in ing why he pressedRESULTSP a tien t N o . B -7 . A fte r ran dom ly exp lo r-ing the effects of s tim ulatio n w ith presses

of each o f th e 3 bu tto ns, P a tien t N o . B -7a lmo s t exc lusiv e ly pressed the sep ta l bu t-to n (F ig . 2 ).

Stimulat ion to the m esencephalic teg -m en tum resu lted in a prom p t ale rtin g , bu tw as quite ave rs ive . T he pa tien t, com pla in -in g o f in tense d iscomfort an d look ing fear -f iil, requ es ted tha t th e s tim u lu s no t be re -

th e sep tal b u tton w ith such frequency ,s tated that the feeling w as good; it wasas if h e w ere bu ild ing up to a s ex u a l o r-gasm . H e reported th at he w as unab le toach ieve the o rgastic end po in t, h ow ev er ,explain ing th at h is frequ en t, some t imesf rantic , push ing of th e butto n w as an at-tem p t to reach the end po in t. T h is fu tileeffo r t w as frustra ting at tim es and desc ribedby h im on these occasion s as a ne rvousfeeling.Pa tien t N o . B -JO . S tud ie s con duc ted on

peated . To m ake ce rta in tha t th e reg ionw as not stim u la ted , he in gen iou sly m od i-fled a h air p in to fit unde r th e butto n w h ichd irec ted a p u lse tra in to th e m es en ce ph alictegmen tum so it cou ld no t b e d ep ressed .

H ippo cam pa l s tim u la tion w as m ild ly re -ward ing .

S t imu lat ion to the sep tal reg ion w as them ost rew ard ing o f th e stim ula tio ns and ,add itiona lly , it a le rted th e patien t, the rebycombatt ing the n arco lepsy . B y v irtu e o f h isab ility to cont r o l symp toms w ith th e stim u-

the psy chom oto r ep ilep tic p a tien t w erem ore v aried and p rov ided m ore in fo rma-tion con cern ing sub jectiv e responses . T heav erage num ber of bu tto n presses pe r hourfo r va rio us reg io ns o f the b rain is lis ted inT ab les 1 and 2 . R egion s o f the b ra in a rel is ted in ord er o f th e frequency w ith w hichthey w ere selec tive ly st imu lated by th esub jec t. A summary o f th e prin cip a l sub-jec tiv e feeling s is g iven .

The bu tto n m o st frequ en tly p ushed pro -v ided a stim ulu s to th e cen trom edian th ala -

1963 1 ROBERT C . HEATH 57 3


4/7

57 4 ELECTR ICA L S ELF-STIMULATION OF THE BRA IN IN MAN [DecemberTA BLE 1

ICSS in M anReward (?) Sites

lESION ST IMULATED AV ERAG E /H OUR SU B JECT IV E RESPONSEL C en tr om e dia n 488 .8 P artia l m em ory re ca ll; a ng er a nd fru stra tio nR.P. Septal 394.9 Feel great; sexual th oughts; eliminationof bad thoughtsL C audate 373.0 C o ol t a st e ; l ik e it O K M e se nc ep h. T eg . 280 .0 D runk fee ling ; happy bu tton ; e lim ina tion o f bad though tsA . A m ygda la 257 .9 Ind iffe ren t fee ling ; som ew ha t p leasan t, bu t fee ling no t in tenseP . Am ygda la 224 .0 M odera te ly rew a rd ing ; in c rease o f cu rren t reques ted

TA BLE 2ICSS in M anA ve rs iv e S it eS

R E G IO N S T IM U L AT E D AVERAGE/HOUR S U BJ EC TI VE R E SP O NS ER. Hippocampus 1.77 Stronglyaversive; feel s ick a ll o ve rL P a rao lfa c to ry 0 .36 M ode ra te ly ave rs iveR . P arie ta l C orte xR . F ro nta l C orte x

0.50 10 .00 N o s ign ifican t sub je c tive response

R . O cc ip ita l C o rte x 0 .00R . T em po ra l C orte x 0.00

mus. T his st imu lus d id no t , how ever, in -duce th e m ost p leasu rab le re sponse ; infact, it in du ced irri tab ility . T he sub ject re-ported tha t he was a lm os t ab le to reca ll amemo ry durin g th is s tim u la tion , bu t hecould not qu ite g rasp it. T he frequen t self-stim u la tion s w ere an endeavo r to brin g thiselus ive m em ory in to c lea r f ocus .

T he patien t m ost consis ten tly reportedp leasu rab le fee lin gs w ith stim ula tion totw o e lec trod es in th e sep ta l reg ion and onein th e m es en ce ph alic t egmen tum . W ith thep lea su rab le respon se to sep ta l s tim uli, hefrequen tly p rod uced assoc ia tions in th esexua l a rea. A c tua l con ten t v aried con-s ide rab ly , b u t regard less o f h is basel ineem otion a l s ta te and th e sub jec t unde r d is-cussion in the room , th e stim ulatio n w asaccom pan ied by th e p atien ts in trodu ctio nof a sex ua l sub jec t, u sua lly w ith a b ro adgrin . W hen question ed abo u t th is , hew ou ld say , I don t kn ow w hy th a t cam eto m ind-I jus t h appened to th ink o f it.T he happy feelings w ith m esencep ha licstim u la tion w ere no t accom pan ied by sex -ua l though ts .

P a tien t N o . B-10 also describ ed as good ,bu t som ew ha t le ss in p leasu rab le-y ield ingqua lity , s tim u li to tw o sites , th e a my gd alo idnuc leus an d the cau da te nu cleus . S eve ra l

o ther septal electrodes and one o the r elec-t rode in th e am ygda lo id nu cleus were st im-ula ted a m odera te num ber of tim es. H isrepo rts con ce rn ing these s tim u lation s sug-gested a le sse r m agn itu de o f p leasurab le re -spon se, b u t d efin ite ly no t an unp leasan tfeel ing .

M in im a l po sitiv e respon se w as ob tainedw ith s tim u la tion of sev era l o the r sep talelectrodes. T he mos t ave rs ive re spon se( sic k fe elin g) w as ob tained w ith s tim u la-tion to one h ippocam pa l e lectro de and onelead in the p a rao lfac to ry area . W ith stim u -la tion of th e la tte r lead , h e com pla in ed o flig h t fla shes , app a ren tly due to spread tothe op tic ne rv e, and o f gene ral d iscomfort .

N o con sisten t changes , e ith er s ig n ifican tlyav ers iv e o r rew ard ing , w ere d isp lay ed w iths tim ula tio n to any o f 12 co rtical lead s d is-pe rsed w id ely ove r the co rtical su rface, in -c lud ing th e fron ta l, tem po ral, occ ip ital, an dparietal lobes .

In the second part o f the study the 3elec trod es w h ich w ere stim u lated m ost dur-ing the firs t ph ase o f the s tudy w ere a t-tach ed to the 3 bu tton s . T he site s o f th eseelectrodes w ere the cen trom ed ian tha lam us,the sep ta l reg ion , an d th e m ese nc ep ha lictegm en tum . D ata ind ica ted th at the com -bin ation o f s ite s ava ilab le in flu en ced th e


5/7

19631 ROBERT C . HEATH 575

CS SCompar is on of R eward S ites

2P oH in t B O (R H)

3Hou r s

- -- .,, . -- r

num ber o f tim es tha t a g iven reg ion o f thebra in w as stim ula ted (F ig . 3 ). W hen cou-p led w ith the sub jec tiv e reports , th e d ataa lso su gg este d tha t the over-a ll s ta te o f th esub ject a t a g iven m om ent w as an in fluen -tia l de te rm in an t fo r se lectin g the reg ion tobe stim ula ted . Fo r ex am p le, the cen tro -median thalamus w as stim ulated up to1 ,100 tim es p er hour w hen in com b ina tio nw ith re lative ly inactive si tes o f st im u la tio nand on ly a max imum o f 29 0 t imes p e r h ourw hen in com b ina tio n w ith tw o o the r h igh lyrew ard ing a reas , th e sep ta l reg ion and them esencepha lic tegm entum .

F IG UR E 3Com par iso n o f F req uency o f S tim u la tio n to Rew ard S ite s

in th e B ra in o f Pa tie n t w ith Psychom o to r E p ilep sy

The pa tien t n o ted tha t the frustra tion andange r resu l t ing from stim u lation of th ecen trom ed ian th alam us w as allev iated w iths tim ula tio n to th e sep ta l reg ion and to them esencepha lic tegm en tum . A s Figure 3 in -d ica tes , the p atien t du ring the f irs t tw ohou rs s tim u lated th e cen trom edian tha lam usm ost frequen tly . T h is w as assoc ia ted withd iscomfort in h is a ttem p t to recap ture af lee ting m em ory . H e reported tha t s timula-tio n o f th e o the r a reas re lieved th is d is-com fort . T h ere w as li ttle activ ity du ringth e n ex t tw o hou rs. T ow ard the end o f th es tudy , in th e 5th and 6th hours , st im u la tionto sep tal and tegm enta l leads inc reased .D uring th e 5 th hour, the m esencepha lictegm en tum was stim ulated m ost frequen tly ;du ring the 6 th hour, the sep tal lead w asstim u la ted m ost freq uen tly . T h e pa tien tevolv ed a pa tte rn coupling the st imu lusto th e cen trom edian th alam us (w hich

stir red h is cu rio sity concern ing the m em -ory ) w ith st imu li to the m o re p leasu rab leareas to lessen the fee lin g of fru s tration .6D ISCUSSION

Changes in pa ram e ters of st imu li to ag iv en reg ion o f the bra in , in clud ing cur-ren t in tensity , w av e fo rm , pu lse w id th , andfrequency , in m any in stances alte red thepa tien ts resp on ses . T h is has s im ilarly beenreported w ith an im a l IC SS .

In fo rmation acqu ired from th e pa tien tsreporting o f the ir reasons fo r b u tton press -ing ind ica tes tha t a ll IC SS is n o t so le ly fo rpleasu re . T he h ighest rate o f bu tton press-ing o ccurred w ith P a tien t N o . B -7 w hen hew as som ewha t frus tra ted in h is p leasu rab lepursu it and as h e a ttem pted to ach iev e anorg astic end po in t. In P a tien t N o . B -10 thehighest rate of bu tton press in g a lso oc -cur red w ith frus tra tion , bu t of a d ifferen ttyp e, evo lv ing w ith attem pts to brin g intofocus a v ague m em ory th at IC SS hadevoked . T he sub jec ts em o tion al s ta te inth is in stance b u ilt in to strong ang er . I tw as in tere s ting th at th e p a tien t w ould bu t-ton press to stim u la te th e reg ion w ith in th ecen trom ed ian tha lam us for a pro longedpe riod , bu t at a s low er ra te w hen bu tton sprov id ing more pleasu rab le sep ta l and teg -m ental stim u la tion w ere also ava ilab le. D e-pression of the sep tal b u tto n , w ith re su ltan tpleasan t feeling s, allev ia ted the p a infu l

6When th e pape r w as presen ted , it w as heretha t the 1 6 mm . so und f ilm w as sh ow n. C lin ica le ffec ts o f stim ula tion to a varie ty of deep reg ionsof th e bra in , as summ arized here in , w ere dem on -st rated .In th e la st sequ en ce o f the ifim , P atien t N o .B -1 0 , the p sychom oto r ep ilep tic , w as stim ula ted inth e septa l reg ion during a p erio d w hen he w asexh ib itin g ag ita ted , v io len t p sycho tic b eh av io r . T h es t imulus w as in t roduced without hi s knowledg e .Almo s t instantly h is b eh av io ral s ta te chan ged fromon e of d iso rgan iza tion , rage , an d pe rsecu tion toon e o f hap p iness and m ild euphoria. H e desc rib edthe b eg inn in g of a sexua l m otive s ta te . H e w asunab le , w h en questio ned d irec tly , to ex p la in th esudden sh ift in h is feelings an d though ts. T hisseq uence of film was p resen ted to dem ons trate ap henom enon which appears to b e cons isten t an dw hich has been rep ea ted in a la rge number ofpat ien ts in o ur labo rato r ies . This phenom enon isth e ability to ob lite ra te imm edia te ly pa in fu lem ergency em otio na l fee lings in a h um an sub jec tth rough in troduction of a p lea su rab le state byphys ica l o r ch em ica l techn iqu es .


6/7

57 6 ELECTRICAL SELF-STIM ULATION OF THE BRA IN IN MAN 1 December- F IG U RE 4S ubco rtica l and C ortica l R ecord ing s from P atien t w ithPsychom oto r Ep ile p sy du ring P sycho t ic Ep isode . Th isR eco rd w as O b ta ined Du r ing th e T im e th a t th e B ase lin eo f the Las t Sequence o f F ilm (D esc rib ed He re in ) w asTaken . N o te th e P redom inan t Sp ik ing Loca l iz ed Prin-c ipa l ly to th e Sep ta l Leads . Th is has P roved to be aCons is ten t Phys io log ica l C o rre la te w ith P sycho tic B e -

hav io r

LAT - LM ICx f

LS Sep$S(L)

C enSS1M )LSe SS (L ) 5O v1 j 5- RH B -tO 4-29-6 3

F IG UR E 5In C on tra s t to the Reco rd ing in Figure 4, th is Is aBase lin e R ecord o f the Type D isp layed by the P atien tw ith P sy ch om oto r E pilep sy D ur in g h is U su al N on psy ch ot ic

B eh av io ra l S ta te

L ATLM C#{231}, ,I FOR )R IW4 c1 1 jr y1 j f tQ \M#N / .

RPSep -L CauLCou -RHyp

LD LVAm

LSepSS ( L )

RH B- tO 4- 29- 63

em ergen cy state, accord ing to the sub jectsreport, and the reby prov id ed him comfo r tto p ursu e h is qu est fo r th e f lee ting m em ory .

W ith sep ta l s tim u la tio n in o the r p atien ts ,as w ell a s the tw o sub jec ts d iscu ssed here ,a sexua l m o tiv e s ta te has frequ en tly b eenindu ced in asso c ia tio n w ith the p leasu rab lere sp onse . T h is sex ua l sta te has no t deve l-oped in assoc ia tio n w ith p leasurab le fee l-ing s durin g stim ulatio n to o the r reg ions .T he consis ten t obse rva tio n of a re la tion be -tw een sexua l feeling s and stim ulation tothe sep ta l reg ion has been desc ribed byM acL ean in m onkey experim ents( 13).T hese repo rts , in p art , answ er question sra ised by G a lam bo s rega rd ing IC SS w henhe asked , W ha t m otiva te s these an im alsto do su ch unhea rd-of-th in gs? Is it som eexquis ite p leasu re th ey rece ive , as seve ralstuden ts of the p rob lem staunch ly contend ,or the feel ing o f u tte r and com p le te w e ll-be ing as o th ers c la im ? (4 ).

T h e IC SS techn iques rep re sen t o ne o fseve ra l m e thodo log ie s th at th e Tu lan e re -sea rche rs have u sed in m an to investiga teth e p leasurab le phenom enon assoc iated

w ith ce rta in typ es of ce reb ral ac tiv ity .T hese stu d ie s com p lem ent ea rly subco rtica lelec trica l s tim u la tion s tud ie s(S ). T h e p lea s-urable response has a lso b een induced inm an w ith in tro duction o f certain ch em icalsin to specific deep brain reg ion s(8-10 ). Itis n o tew orthy th a t in ten se p leasurab le re -spon ses in duced w ith chem ica l st imu lat iono f th e b ra in occu rred w h en a h ig h ampl i -tud e sp ind ling type of record ing w as se tup in th e sep ta l reg ion (F igs . 6 and 7 ).

T he obse rva tio n tha t in troduc tio n of ast imu lus w hich induces p leasure im m ed i-ate ly e lim ina te s p a in fu l em erg en cy sta tesis qu ite consis ten t. if o ur p sy ch o dyn am icformulations ar e correct, th is basic ob se rv a-tion m ay have w idespread im plica tion fo rthe d ev elopm ent of th erapeu tic m e thod s toalter favo rab ly d iso rde red behav ior.

Sur yS tud ie s ar e desc ribed o f tw o hum an pa -

tien ts u nde r trea tm en t w ith ICSS . The i rsu b jective reports in asso cia tio n w ith s tim u -la tio n to rew ard areas of th e b rain are p re-sen ted . T he da ta ind icate tha t pa tien ts w ill


7/7

RO BERT C . H EATH

F IG U RE 6Base lin e R eco rd o f Ep ilep tic P a tien t N o. 65

RPH I (L )

st imu late reg ion s of th e bra in at a h ighfrequency fo r reasons o the r th an to obta ina p leasu rab le re spo nse . T hese d ata ex tendin fo rm a tio n obtain ed from IC SS in an im a ls .

B IBL IOGRAPHY1 . B ecker, H . C ., e t a l.: In : S tud ies in

Schizoph ren ia. C am bridge : Harv a rd Un iv .P ress , 1954 , p . 5 65 .

2 . B ecke r , H . C ., e t a !.: Electroenceph .C lin . N europhysio l., 9 : 5 33 , 1957 .3 . B ish op , M . P ., e t a ! .: Science, 140 : 394 ,

1963 .4 . G a lam bos , R ob e rt: F ed . Pro c., 20 : 603 ,

1961 .5. Heath , R . G ., e t a t.: S tud ie s in Schizo-

phren ia . C am bridge : H arva rd U n iv . P re ss ,195 4 , p . 42 , 46 , 4 7 , 5 0 ,560 .

6 . H eath , R . C .: P sycho som . M ed ., 1 7 :3 83 , 195 5 .

7 . H ea th , R . C .: C onfin ia N euro l., 18:305 , 195 8 .

8 . H ea th , R . C .: In H eath , R . C . (Ed .) :

57 7FIGURE 7

R eco rd ing from E p ile p tic P a tien t N o . B -5 F ollo win gIn jec tio n o f A cety lch olin e in to th e S ep t3 1 R eg io n

th ro ug h ln trac e reb ra l C an nu la

A ,

-

P leasu re In tegra tio n and B ehav ior. N ew Y ork :Hoeb er . In p res s .

9 . H eath , R . C ., and deB a lb ian V ers te r, F .:Am . J . P sych iat., 117 : 980 , 1961 .10 . H ea th , R . C ., and Found s, W . L .:E lectro en ceph . C lin . N eu rophysio l., 1 2 : 930 ,1960 .

11 . H eath , R . C ., et a !.: In : S tu d ie s inSchizoph ren ia. C am brid ge : Harv a rd Un iv .P ress , 1954 , p . 555 .12 . H ea th , R . C ., and M ick le , W . A .: InR am ey , R . R ., and O D oherty , D . S . (Eds. ) :Electrical Stud ies on the U nanesth etized B rain .N ew Y ork : H oeber, 1960 .

13 . M acL ean , P . D ., e t a !.: Trans. Am .Neu ro l . A ss ., 84 : 1 05 , 19 59 .

1 4 . O lds , J .: Physio l. R ev ., 42 : 554 , 1962 .15. _________ : A m . J . Phy sio l., 1 99 : 965 ,

1960 .1 6 . O lds , J. , and M im er, P .: J . C om p . Phy s-

io l. P sycho l., 47 : 419 , 19 54 .17 . O lds , J ., an d O lds, M . E .: In Hea th ,

R . C . (E d .): P leasure In teg ratio n and B e-h av io r . N ew Y ork : H oebe r . In p re ss .

Documents

Electrical Self-stimulation of the Brain