Persistent genital arousal disorder associated with functional hyperconnectivity of an epileptic focus

• Published in: Neuroscience Vol. 167; no. 1; pp. 88 - 96
• Main Authors: Anzellotti, F, Franciotti, R, Bonanni, L, Tamburro, G, Perrucci, M.G, Thomas, A, Pizzella, V, Romani, G.L, Onofrj, M
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 28.04.2010; Elsevier
• Subjects: Adult; Anticonvulsants - pharmacology; Anticonvulsants - therapeutic use; Biological and medical sciences; Brain - drug effects; Brain - physiopathology; Brain Mapping; Electroencephalography; epilepsy; Epilepsy - drug therapy; Epilepsy - physiopathology; Female; fMRI; Follow-Up Studies; Fructose - analogs & derivatives; Fructose - pharmacology; Fructose - therapeutic use; functional connectivity; Functional Laterality; Fundamental and applied biological sciences. Psychology; Genital Diseases, Female - drug therapy; Genital Diseases, Female - physiopathology; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Magnetic Resonance Imaging; Magnetoencephalography; Medical sciences; Nervous system (semeiology, syndromes); Neural Pathways - drug effects; Neural Pathways - physiopathology; Neurology; posterior insular cortex; Treatment Outcome; Vertebrates: nervous system and sense organs; epilepsy; LPIG; right middle frontal gyrus; left middle temporal gyrus; LITG; right middle temporal gyrus; posterior insular cortex; Minnesota Multiphasic Personality Inventory 2; LSTG; BOLD; IC; LIPL; RMFG; persistent genital arausal disorder; left frontal eye field; LMFG; EEG; MEG; fMRI; PCC; left inferior parietal lobe; LFEF; MMPI-2; FC; functional magnetic resonance imaging; right inferior parietal lobe; independent component; RITG; equivalent current dipole; RSTG; blood oxygen level-dependent; posterior cingulum cortex; RIPL; SFG; electroencephalography; ECD; left middle frontal gyrus; left posterior insular gyrus; superior frontal gyrus; left superior temporal gyrus; LMT; functional connectivity; RFEF; right inferior temporal gyrus; right superior temporal gyrus; RMT; right frontal eye field; magnetoencephalography; left inferior temporal gyrus; PGAD; Nervous system diseases; Magnetoencephalography; Epilepsy; Central nervous system; Nuclear magnetic resonance imaging; Encephalon; Cerebral disorder; Central nervous system disease; Insular cortex; Functional imaging
• ISSN: 0306-4522; 1873-7544
• DOI: 10.1016/j.neuroscience.2010.01.050

Abstract Persistent Genital Arousal Disorder (PGAD) refers to the experience of persistent sensations of genital arousal that are felt to be unprovoked, intrusive and unrelieved by one or several orgasms. It is often mistaken for hypersexuality since PGAD often results in a high frequency of sexual behaviour. At present little is known with certainty about the etiology of this condition. We described a woman with typical PGAD symptoms and orgasmic seizures that we found to be related to a specific epileptic focus. We performed a EEG/MEG and fMRI spontaneous activity study during genital arousal symptoms and after the chronic administration of 300 mg/day of topiramate. From MEG data an epileptic focus was localized in the left posterior insular gyrus (LPIG). FMRI data evidenced that sexual excitation symptoms with PGAD could be correlated with an increased functional connectivity (FC) between different brain areas: LPIG (epileptic focus), left middle frontal gyrus, left inferior and superior temporal gyrus and left inferior parietal lobe. The reduction of the FC observed after antiepileptic therapy was more marked in the left than in the right hemisphere in agreement with the lateralization identified by MEG results. Treatment completely abolished PGAD symptoms and functional hyperconnectivity. The functional hyperconnectivity found in the neuronal network including the epileptic focus could suggest a possible central mechanism for PGAD.