The perspectives of mapping and monitoring of the sense of self in neurosurgical patients

Surgical treatment of tumors, epileptic foci or of vascular origin, requires a detailed individual pre-surgical workup and intra-operative surveillance of brain functions to minimize the risk of post-surgical neurological deficits and decline of quality of life. Most attention is attributed to language, motor functions, and perception. However, higher cognitive functions such as social cognition, personality, and the sense of self may be affected by brain surgery. To date, the precise localization and the network patterns of brain regions involved in such functions are not yet fully understood, making the assessment of risks of related post-surgical deficits difficult. It is in the interest of neurosurgeons to understand with which neural systems related to selfhood and personality they are interfering during surgery. Recent neuroscience research using virtual reality and clinical observations suggest that the insular cortex, medial prefrontal cortex, and temporo-parietal junction are important components of a neural system dedicated to self-consciousness based on multisensory bodily processing, including exteroceptive and interoceptive cues (bodily self-consciousness (BSC)). Here, we argue that combined extra- and intra-operative approaches using targeted cognitive testing, functional imaging and EEG, virtual reality, combined with multisensory stimulations, may contribute to the assessment of the BSC and related cognitive aspects. Although the usefulness of particular biomarkers, such as cardiac and respiratory signals linked to virtual reality, and of heartbeat evoked potentials as a surrogate marker for intactness of multisensory integration for intra-operative monitoring has to be proved, systemic and automatized testing of BSC in neurosurgical patients will improve future surgical outcome.

Visuo-vestibular mechanisms of bodily self-consciousness

Joachim Jean-Marie Forget

Bodily self-consciousness is linked to multisensory integration and is particularly dependent on vestibular perception providing the brain with the main sensory cues about body motion and location in space. Vestibular and visual inputs are permanently balanced and integrated to encode the most optimal representation of the external world and of the observer in the central nervous system. Vection, an illusory self-motion experience induced only by visual stimuli, illustrates the fact that the visual and the vestibular systems share common neural underpinnings and a similar phenomenology. Optokinetic stimulation inducing vection and direct vestibular stimulation induce whole-body motion sensations that can be used to explore multisensory interactions. A failure in visuo-vestibular integration, artificially induced by the methods of cognitive psychology or in pathological conditions, has also been reported to altered own body perception and bodily self-consciousness. The respective contributions of the vestibular and visual systems to bodily self-consciousness amongst other polymodal sensory mechanisms, and the neural correlates of visuo-vestibular convergence, should be better understood. We first performed a neuroimaging study of brain regions where optokinetic and vestibular stimuli converge, using 7T functional magnetic resonance imaging in individual subjects. We identified three main regions of convergence: (1) the depth of supramarginal gyrus or retroinsular cortex, (2) the surface of supramarginal gyrus at the temporo-parietal junction, (3) and the posterior part of middle temporal gyrus and superior temporal sulcus. Then, we aimed to induce the embodiment of an external fake rubber hand through visuo-tactile conflict - the so-called rubber hand illusion paradigm, and studied how this integration is modulated by vection. Subjects experiencing vection in the direction of the rubber hand mislocalised the position of their real hand towards the rubber hand indicating that visuo-vestibular stimuli can enhance visuo-tactile integration. We also investigated if visuo-proprioceptive and tactile integration in peripersonal space could be dynamically updated based on the congruency of visual and proprioceptive feedback. A pair of rubber hands or feet provided visual feedback. Fake and real limbs were crossed or uncrossed. We showed that sensory cues were integrated in peripersonal space, dynamically reshaped but only for hands. Finally, we investigated a rare case of an illusory own body perception in an epileptic patient suffering from multiple daily disembodiments during seizures. Seizures were associated to a focal cortical microdysplasia juxtaposed to a developmental venous anomaly in the left angular gyrus, a brain region known to be important for visuo-vestibular integration and bodily self-consciousness. Our results characterize the inferior parietal lobule as a crucial structure in merging visual, vestibular, tactile and proprioceptive inputs, allowing the emergence of the global and unified experience of being âI.â Multisensory body representation can be reshaped transiently using visual and vestibular signals or in relation to a medical condition affecting the temporo-parietal junction. The integration of visual and vestibular signals, aims to adapt dynamically our internal representations to constant changes occurring in our environment.

EPFL2015

Neuroscience of Bodily Self-Consciousness

Olaf Blanke, Estelle Palluel, Christian Pfeiffer

We review recent research about human subjectivity and self-consciousness that has focused on cognitive psychology and neuroimaging of bodily self-consciousness. Multidisciplinary research on the fields of neurology, cognitive neuroscience and virtual reality opens new avenues to investigate brain mechanisms underlying a fundamental sense of the bodily self. Clinical evidence for the implication of right temporo-parietal junction for bodily self-consciousness has received support by studies in which virtual-reality based own body illusions are evoked in healthy participants to study the underlying processes. A series of experiments will be reviewed in which it was shown that the experiences of self-location, self-identification and the first-person perspective can be manipulated experimentally and rely on the integration of multisensory stimuli (touch, vision, proprioception, vestibular information). Specific protocols are available to predictably influence the different aspects of bodily self consciousness. We predict that the understanding of fundamental brain mechanisms of bodily self-consciousness will lead to unprecedented empirical insights that are of broad relevance for science, virtual reality, engineering, the humanities, as well as medicine and psychotherapy.

2011

Turning Body and Self Inside Out

Lukas Heydrich

What is the self? This major philosophical question has been considered too complex to be studied in neuroscience. However, during the last 20 years, researchers from different disciplines within the cognitive neurosciences have started investigating the neural correlates of self-consciousness, using a range of behavioural paradigms and functional imaging techniques. Where as many researchers have studied highorder representational aspects of self-consciousness, such as language (i.e. the use of the self-referential pronoun "I" or "Me"), converging evidence suggests that the most basic sense of self, e.g. the sensation that we possess a stable and coherent representation of our body, that we identify with our body and that we perceive the self as being located within the bodily boundaries (e.g. bodily self-consciousness), is due to integration of bodily signals from different exteroceptive sensory modalities (vision, touch, proprioception). Others have highlighted the importance signals related to internal signals (homeostasis, interoception) for self-consciousness. Using lesion analysis, we could demonstrate a causal link between damage to the right temporo-parietal junction and an altered state of bodily self-consciousness, e.g out-of-body experiences. This was confirmed using functional magnetic resonance imaging, multisensory exteroceptive conflicts and virtual reality: if healthy participants perceived themselves as "disembodied", activity in the same cortical region (i.e. temporo-parietal junction) was systematically modulated. Moreover, we were able to demonstrate in a second line of experiments that interoceptive signals can be used to systematically alter bodily self-consciousness and somatosensory processing, extending previous paradigms that focused exclusively on exteroceptive signals. This was strengthened by our finding that the left posterior insula, repeatedly linked to the representation and integration of internal and external bodily signals, is implicated in another state of altered bodily self-consciousness, e.g. heautoscopy. Our results demonstrate that bodily self-consciousness is based on a neural network that represents and integrates both external and internal signals from the body.