Blunted perception of breathlessness in three cases of low grade insular-glioma

Journal article

Better understanding of breathlessness perception addresses an unmet clinical need for more effective treatments for intractable dyspnoea, a prevalent symptom of multiple medical conditions. The insular-cortex is predominantly activated in brain-imaging studies of dyspnoea, but its precise role remains unclear. We measured experimentally-induced hypercapnic air-hunger in three insular-glioma patients before and after surgical resection. Tests involved one-minute increments in inspired CO2, raising end-tidal PCO2 to 7.5 mmHg above baseline (38.5 ± 5.7 mmHg), whilst ventilation was constrained (10.7 ± 2.3 L/min). Patients rated air-hunger on a visual analogue scale (VAS). Patients had lower stimulus–response (2.8 ± 2 vs. 11 ± 4 %VAS/mmHg; p = 0.004), but similar threshold (40.5 ± 3.9 vs. 43.2 ± 5.1 mmHg), compared to healthy individuals. Volunteered comments implicated diminished affective valence. After surgical resection; sensitivity increased in one patient, decreased in another, and other was unable to tolerate the ventilatory limit before any increase in inspired CO2.We suggest that functional insular-cortex is essential to register breathlessness unpleasantness and could be targeted with neuromodulation in chronically-breathless patients. Neurological patients with insula involvement should be monitored for blunted breathlessness to inform clinical management

Authors: Chapman, TP; Farrell, SM; Plaha, P; Green, AL; Moosavi, SH

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Frontiers Media
• Journal: Frontiers in Neuroscience
• Volume: 18
• Pages: 1339839-1339839
• Article number: 1339839
• Publication date: 2024-02-12
• DOI: 10.3389/fnins.2024.1339839
• EISSN: 1662-453X
• ISSN: 1662-4548
• Language: English
• Keywords: Psychiatry; Medicine; Glioma; Insula; Stimulus (psychology); Anesthesia; Psychology; Physical therapy; Visual analogue scale; Neuroscience; Insular cortex