Brain Advance Access originally published online on November 30, 2006
Brain 2007 130(1):88-99; doi:10.1093/brain/awl329
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The dreamy state: hallucinations of autobiographic memory evoked by temporal lobe stimulations and seizures
1 Service de Neurologie, Hôpital Central, CHU de Nancy Nancy 2 Faculté de Medecine, Université Nancy Nancy 3 Laboratoire de Neurophysiologie et Neuropsychologie-U751, INSERM Marseille, Université de la Méditerranée Marseille Cedex, France
Correspondence to: Dr Jean-Pierre Vignal, Service de Neurologie, Hopital Central, C.O. n 34, 54035 Nancy Cedex, France E-mail: jp.vignal{at}chu-nancy.fr
Using results from cortical stimulations, as well as the symptoms of spontaneous epileptic seizures recorded by stereoelectroencephalography we re-studied the phenomenon of the dreamy state, as described by Jackson (Jackson JH. Selected writings of John Hughlins Jackson. Vol 1. On epilepsy and epileptiform convulsions. Taylor J, editor. London: Hodder and Stoughton; 1931). A total of 15 sensations of déjà vécu, 35 visual hallucinations consisting of the image of a scene and 5 ‘feelings of strangeness’ occurred. These were recorded during 40 stimulations in 16 subjects, and 15 seizures in 5 subjects. Forty-five per cent of dreamy states were evoked by stimulation of the amygdala, 37.5% by the hippocampus and 17.5% by the para-hippocampal gyrus. During both spontaneous and provoked dreamy state, the electrical discharge was localized within mesial temporal lobe structures, without involvement of the temporal neocortex. Early spread of the discharge to the temporal neocortex appeared to prevent the occurrence of the dreamy state. Semiological analysis showed a clinical continuity between déjà vécu and visual hallucinations, the latter often consisting of a personal memory that was ‘relived’ by the subject; such memories could be recent, distant or from childhood. With one exception, the particular memory evoked differed from one seizure to another, but were always drawn from the same period of the subject's life. Given the role of the amygdala and hippocampus in autobiographic memory, their pathological activation during seizures may trigger memory recall. This study of the dreamy state is in keeping with other evidence demonstrating the constant and central role of the amygdala and hippocampus (right as much as left) in the recall of recent and distant memories. It demonstrates the existence of large neural networks that produce recall of memories via activation of the hippocampus, amygdala and rhinal cortex.
Key Words: dreamy state; autobiographic memory; amygdala; hippocampus; cortical stimulation
Abbreviations: MTL, mesial temporal lobe; SEEG, stereoelectroencephalography
Received March 20, 2006. Revised September 12, 2006. Accepted October 19, 2006.