title: Seeing scenes: topographic visual hallucinations evoked by direct electrical stimulation of the parahippocampal place area.
abstract: In recent years, functional neuroimaging has disclosed a network of cortical areas in the basal temporal lobe that selectively respond to visual scenes, including the parahippocampal place area (PPA). Beyond the observation that lesions involving the PPA cause topographic disorientation, there is little causal evidence linking neural activity in that area to the perception of places. Here, we combined functional magnetic resonance imaging (fMRI) and intracranial EEG (iEEG) recordings to delineate place-selective cortex in a patient implanted with stereo-EEG electrodes for presurgical evaluation of drug-resistant epilepsy. Bipolar direct electrical stimulation of a cortical area in the collateral sulcus and medial fusiform gyrus, which was place-selective according to both fMRI and iEEG, induced a topographic visual hallucination: the patient described seeing indoor and outdoor scenes that included views of the neighborhood he lives in. By contrast, stimulating the more lateral aspect of the basal temporal lobe caused distortion of the patient's perception of faces, as recently reported (Parvizi et al., 2012). Our results support the causal role of the PPA in the perception of visual scenes, demonstrate that electrical stimulation of higher order visual areas can induce complex hallucinations, and also reaffirm direct electrical brain stimulation as a tool to assess the function of the human cerebral cortex.
authors.affiliation: Departments of Neurosurgery, Feinstein Institute for Medical Research, Neurology, and Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York 11030, and Neuroscience Institute, Princeton University, Princeton, New Jersey 08540.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mégevand
authors.forename: David M
authors.initials: DM
authors.lastname: Groppe
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Goldfinger
authors.forename: Sean T
authors.initials: ST
authors.lastname: Hwang
authors.forename: Peter B
authors.initials: PB
authors.lastname: Kingsley
authors.forename: Ido
authors.initials: I
authors.lastname: Davidesco
authors.forename: Ashesh D
authors.initials: AD
authors.lastname: Mehta
mesh_terms: D001931:Brain Mapping; D046690:Deep Brain Stimulation / Q000379:methods*; D004569:Electroencephalography; D006212:Hallucinations / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D010100:Oxygen / Q000097:blood; D020534:Parahippocampal Gyrus / Q000098:blood supply / Q000503:physiopathology*; D013702:Temporal Lobe / Q000503:physiopathology; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: direct electrical stimulation; functional magnetic resonance imaging; intracranial electroencephalography; parahippocampal place area; scene perception; visual hallucination
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