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. 2004 Apr 20;101(16):6217-21.
doi: 10.1073/pnas.0307048101. Epub 2004 Mar 16.

Activation of human medial prefrontal cortex during autonomic responses to hypoglycemia

Denise Teves  1 , Tom O Videen, Philip E Cryer, William J Powers
Affiliations

Activation of human medial prefrontal cortex during autonomic responses to hypoglycemia

Denise Teves et al. Proc Natl Acad Sci U S A. .

Abstract

Studies in humans implicate the medial prefrontal cortex (MPFC) in complex cognitive and emotional states. We measured regional cerebral blood flow (CBF) four times each during euglycemia (5.2 +/- 0.2 mmol/liter) and hypoglycemia (3.0 +/- 0.3 mmol/liter) in nine normal human volunteers. Autonomic responses during hypoglycemia were manifested by increases in neurogenic symptoms, heart rate, and plasma levels of epinephrine, norepinephrine, and pancreatic polypeptide. Typical symptoms of hypoglycemia were mild, and none reflected evidence of cognitive or emotional stress. Quantitative CBF fell 6-8% in the cerebrum, brainstem, and cerebellum. Analysis of regional CBF differences identified neuronal activation during hypoglycemia in bilateral MPFC (areas 24 and 32) and bilateral thalamus. These results provide evidence that the MPFC participates in the autonomic responses to simple physiological stimuli in humans.

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Figures

Fig. 1.
Fig. 1.
Symptoms reported during normoglycemia and hypoglycemia. Every 30 min, subjects were asked to score the following symptoms on a linear scale from 0 (none) to 6 (severe): 1, heart pounding (P = 0.002); 2, shaky/tremulous (P = 0.042); 3, nervous/anxious (P = 0.076); 4, sweaty (P = 0.005); 5, hungry (P = 0.007); 6, tingling (P = 0.889); 7, difficulty thinking (P = 0.051); 8, tired/drowsy (P = 0.616); 9, weak (P = 0.047); 10, warm (P = 0.011); 11, faint (P = 0.084); and 12, dizzy (P = 0.030).
Fig. 2.
Fig. 2.
Mean difference images of relative rCBF increases from nine subjects superimposed on the composite structural MR image. The color bar indicates percent increase relative to whole-brain flow and has been fixed at a maximum of 12%. Right brain is on the right. Blue lines on the sagittal sections show the upper and lower limits of brain sampled in all nine subjects. Flow is elevated in thalamus (Thal), MPFC (MPF), right orbital prefrontal cortex (OPF), right globus pallidus (GP), right sensorimotor cortex (SMI), and periaqueductal gray (PAG).
Fig. 3.
Fig. 3.
Mean difference images of relative rCBF decreases from nine subjects superimposed on the composite structural MR image. The color bar indicates percent decrease relative to whole-brain flow and has been fixed at a minimum of -12%. Right brain is on the right. Blue lines on the sagittal section show the upper and lower limits of brain sampled in all nine subjects. Flow is decreased bilaterally in the hippocampus.
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