Published ahead of print on September 5, 2008, doi:10.1164/rccm.200805-731OC
© 2008 American Thoracic Society doi: 10.1164/rccm.200805-731OC
Reduced Perception of Dyspnea and Pain after Right Insular Cortex Lesions1 Department of Psychology, University of Hamburg; 2 Center for Clinical Neurosciences-Department of Neurology, University Medical Center Hamburg-Eppendorf; 3 Center for Clinical Neurosciences-Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf; and 4 Department of Systems Neuroscience/Neuroimage Nord, University Medical Center Hamburg-Eppendorf, Germany Correspondence and requests for reprints should be addressed to Andreas von Leupoldt, Ph.D., Department of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany. E-mail: andreas.vonleupoldt{at}uni-hamburg.de Rationale: The perception of dyspnea and pain show many similarities. Initial imaging studies suggested an important role of the insular cortex for the perception of both sensations. However, little is known about the cortical processing of dyspnea. Objectives: This study investigated the influence of lesions of the insular cortex on the perception of dyspnea and pain. Methods: Dyspnea was induced by resistive loaded breathing in four patients with right-hemispheric insular cortex lesions, as assessed with computer tomography or magnetic resonance imaging, and four matched healthy control subjects. Pain was induced by a cold-pressor test. Perceived intensity and unpleasantness of both sensations were rated on visual analog scales. Measurements and Main Results: In contrast to healthy control subjects, patients with lesions demonstrated reduced perceptual sensitivity for dyspnea, in particular for the unpleasantness of dyspnea (P < 0.05). This was paralleled by reduced sensitivity for pain in patients with lesions, as reflected by smaller ratings of intensity and unpleasantness, higher sensory pain-thresholds, and, in particular, higher affect-related pain tolerance times (P < 0.05). Conclusions: The results suggest that lesions of the right insular cortex are associated with reduced sensitivity for the perception of dyspnea and pain, in particular for their perceived unpleasantness. This underlines the importance of the insular cortex for the perception of both sensations.
Key Words: brain • dyspnea • insular cortex lesion • pain • perception
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