title: Induction of Fear by Intraoperative Stimulation During Awake Craniotomy: Case Presentation and Systematic Review of the Literature.
abstract: OBJECTIVE
  A case is presented and a systematic review of the literature is provided to update our current knowledge of induction of fear by cortical stimulation.
  
  
  METHODS
  We present a case of refractory epilepsy associated with a lesion where fear could be induced by intraoperative electrical stimulation of the posterior inner part of the superior temporal gyrus. We performed a systematic review of the literature using PubMed with the key words "epilepsy AND emotion", "cortical stimulation AND emotion," and "human brain stimulation AND behavior".
  
  
  RESULTS
  Intraoperative cortical stimulation of the inner part of the posterior superior temporal gyrus reliably induced fear and progressive screaming behavior. Stimulation through subdural grid electrodes did not induce this phenomenon. A systematic review of the literature identified fear induction by stimulation of different widespread cortical areas including the temporal pole, the insula, and the anterior cingulate cortex. The posterior part of the superior temporal gyrus has so far not been associated with fear induction after electrical stimulation.
  
  
  CONCLUSIONS
  Although our observation suggests that this area of the brain could be part of a network involved in the elicitation of fear, dysfunction of this network induced by epilepsy could also explain the observed phenomenon. Electrophysiologic and imaging studies must be conducted to improve our understanding of the cortical networks forming the neuroanatomical substrate of higher brain functions and experiences such as fear.
authors: Department of Neurosurgery, University Hospital Bern, 3010 Bern, Switzerland. Electronic address: neuro.nowacki@gmail.com.
authors: Andreas
authors: A
authors: Nowacki
authors: Department of Neurosurgery, University Hospital Bern, 3010 Bern, Switzerland.
authors: Kathleen
authors: K
authors: Seidel
authors: Department of Neurosurgery, University Hospital Bern, 3010 Bern, Switzerland.
authors: Philippe
authors: P
authors: Schucht
authors: Department of Neurology, University Hospital Bern, 3010 Bern, Switzerland.
authors: Kaspar
authors: K
authors: Schindler
authors: Department of Neurology, University Hospital Bern, 3010 Bern, Switzerland.
authors: Eugenio
authors: E
authors: Abela
authors: Department of Neurology, University Hospital Bern, 3010 Bern, Switzerland.
authors: Dorothea
authors: D
authors: Heinemann
authors: Department of Neurology, University Hospital Bern, 3010 Bern, Switzerland.
authors: Klemens
authors: K
authors: Gutbrod
authors: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, 3010 Bern, Switzerland.
authors: Roland
authors: R
authors: Wiest
authors: Department of Neurosurgery, University Hospital Bern, 3010 Bern, Switzerland.
authors: Andreas
authors: A
authors: Raabe
authors: Department of Neurosurgery, University Hospital Bern, 3010 Bern, Switzerland.
authors: Claudio
authors: C
authors: Pollo
mesh_terms: D001931:Brain Mapping; D003399:Craniotomy; D004558:Electric Stimulation; D004827:Epilepsy / Q000601:surgery*; D005239:Fear; D005260:Female; D006801:Humans; D008875:Middle Aged; D013702:Temporal Lobe / Q000502:physiology*
keywords: Awake craniotomy; Direct cortical stimulation; Induction of fear; Temporal lobe epilepsy