Probing the circuitry of panic with deep brain stimulation: Connectomic analysis and review of the literature.
BACKGROUND
Panic attacks affect a sizeable proportion of the population. The neurocircuitry of panic remains incompletely understood.


OBJECTIVE
To investigate the neuroanatomical underpinnings of panic attacks induced by deep brain stimulation (DBS) through (1) connectomic analysis of an obsessive-compulsive disorder patient who experienced panic attacks during inferior thalamic peduncle DBS; (2) appraisal of existing clinical reports on DBS-induced panic attacks.


METHODS
Panicogenic, ventral contact stimulation was compared with benign stimulation at other contacts using volume of tissue activated (VTA) modelling. Networks associated with the panicogenic zone were investigated using state-of-the-art normative connectivity mapping. In addition, a literature search for prior reports of DBS-induced panic attacks was conducted.


RESULTS
Panicogenic VTAs impinged primarily on the tuberal hypothalamus. Compared to non-panicogenic VTAs, panicogenic loci were significantly functionally coupled to limbic and brainstem structures, including periaqueductal grey and amygdala. Previous studies found stimulation of these areas can also provoke panic attacks.


CONCLUSIONS
DBS in the region of the tuberal hypothalamus elicited panic attacks in a single obsessive-compulsive disorder patient and recruited a network of structures previously implicated in panic pathophysiology, reinforcing the importance of the hypothalamus as a hub of panicogenic circuitry.
['Elias|Gavin J B|GJB|', 'Giacobbe|Peter|P|', 'Boutet|Alexandre|A|', 'Germann|Jürgen|J|', 'Beyn|Michelle E|ME|', 'Gramer|Robert M|RM|', 'Pancholi|Aditya|A|', 'Joel|Suresh E|SE|', 'Lozano|Andres M|AM|']
D000328:Adult D000679:Amygdala D063132:Connectome D046690:Deep Brain Stimulation D005260:Female D006801:Humans D007031:Hypothalamus D009415:Nerve Net D009771:Obsessive-Compulsive Disorder D013788:Thalamus
Deep brain stimulation Connectomics Panic attack Inferior thalamic peduncle Hypothalamus Panic disorder