Characterization of the neural correlates of anesthetic-induced intraoperative dream states using stereoelectroencephalography.
David Purger
Primary Investigator
Brief description of study
What is the purpose of this study?
Dreams experienced during emergence from anesthesia have been associated with improvement in trauma-related psychiatric disorders. This study aims to characterize the brain network activity patterns associated with anesthetic-induced intraoperative dreams to gain insight into the underlying mechanisms of the phenomenon and its potential therapeutic effects. Participants will be recruited from a pool of patients with epilepsy scheduled to undergo stereoelectroencephalography (sEEG) for localization of seizure foci. Their clinical care will not be impacted by this study, which does not require any significant deviation from standard surgical or anesthetic protocol. Patients with preexisting psychiatric disorders will be evaluated for any change in symptoms after dreaming.
Detailed description of study
What will happen during the study?
- Beginning 2 weeks prior to their operation, participants will fill in an online sleep and dream log every morning upon awakening, and they will fill in a Daily Mood Questionnaire in the evenings to assess daily mood.
- On the day of their operation in the hospital setting, participants will be interviewed about their current mood using the Daily Mood Questionnaire. Participants will undergo the operation with minimal deviation from standard protocol. sEEG electrodes will remain connected to the recording platform during the emergence process to allow for continuous recording of brain activity during the expected window of dream occurrence. The usual, standard anesthetic agents will be titrated down to precipitate emergence in the usual manner until the expected EEG waveform is seen. If it is not seen, participants will continue to be awoken in the standard fashion. The total length of the emergence process will not deviate by a clinically significant amount of time, to be determined by the attending neuroanesthesiologist assigned to the case.
- After emergence, participants will be interviewed in a structured format regarding their sleep and dream experiences. They will also be interviewed about their current mood (using the same Daily Mood Questionnaire).
- After surgery, patients will be admitted to the Epilepsy Monitoring Unit (EMU) for anywhere from three days to a maximum of two weeks. Participants will continue filling in the online Sleep and Dream Log and the Daily Mood Questionnaire during their stay. They may also continue to be interviewed about their dream experience and their subjective assessment of its impact. Brain activity will continue to be recorded as appropriate from a clinical standpoint. sEEG electrodes will be removed at bedside or in the operating room as clinically indicated. The length of the EMU admission will not be impacted in any way by this study, as patients will be explanted and discharged once it is clinically appropriate to do so, to be determined by the attending epileptologist.
- On post-op day 14, participants will complete their final Sleep and Dream Log and Daily Mood Questionnaires. Also on post-op day 14, participants will be seen in clinic, or in the epilepsy monitoring unit if they have not been discharged, where they will complete the CAPS-5, PHQ-8, and GAD-7 for comparison to baseline.
- Participants will be considered discharged from the study after they have completed the 2-week post-operation sleep and dream log and daily mood questionnaire, and the CAPS-5, PHQ-8, and GAD-7.
Eligibility of study
You may be eligible for this study if you meet the following criteria:
- Conditions: Epilepsy, Epileptic seizure
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Age: 18 years - 100 years
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Gender: All
Inclusion Criteria
• Patients 18 years or older undergoing stereoelectroencephalography for epileptic seizure localization
• Able to read, understand, and provide written, dated informed consent
Exclusion Criteria
• Patients under 18 years old
• Preexisting neurological disorders including: dementia, delirium, or other cognitive disorders, degenerative central nervous system disorder (e.g., Alzheimer or Parkinson disease)
• Any other disease/procedure/accident associated with significant injury to or malfunction of the central nervous system (with the exception of epilepsy, unless associated with major cognitive impairment or significant developmental delay, e.g. Lennox-Gastaut syndrome).
• Current diagnosis of moderate/severe substance or alcohol use disorder
• The following categories of SUD will NOT be excluded: nicotine dependence; mild alcohol or substance use disorder; alcohol or substance use disorder of any severity in remission for ≥ 3 months
