“Laser Ablation of Human Guilt”, 2021-12-01 ():
A 14yo girl (AB) with no previous medical illness began to notice brief but distinct episodes of guilt and distress, occasionally followed by urinary incontinence. In the beginning, the patient attributed these feelings to recent or ongoing events such as “fighting with friends” or “doing something wrong at school”. With time, she became increasingly baffled by these episodes, trying to “figure out if the situation was causing guilt”…For nearly a year the patient kept these episodes to herself until she had a generalized tonic clonic seizure, leading to neurological consultation and epilepsy diagnosis.
…MRI showed a 2.4×1.8×1.3-cm [tumor] mass in the right frontal horn of the lateral ventricle.
…Stimulation of contacts in the anterior hippocampus evoked feelings of guilt and distress as well (Figure 1).
…the patient underwent an MRI-guided laser thermal ablation of the tumor (Supplementary Figure 1), achieving destruction of the medial and posterior part of the tumor abutting the fornix. Post-procedural MRI showed residual tumor in the anterior and ventral part of the lesion bordering the subgenual cingulate gyrus (Figure 1).
The patient had temporary relief but after a few weeks the guilt episodes returned. The patient then underwent a second surgery where the antero-ventral part of the tumor was ablated in the same manner. A postoperative MRI showed ablation of the tumor bordering the subcallosal cingulate (Figure 1). 5 years later, the patient remains free of these guilt episodes or any other seizure phenomena and is off anti-seizure medications.
…the occurrence of these guilt episodes and the ability to elicit them in isolation by specific brain activity, in the absence of a particular cause or social context, suggest that guilt could be a distinct primary human emotion.
[Keywords: guilt, epilepsy, electrical brain stimulation, epileptic aura, brain tumor, laser ablation]
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