Aaron Boes
@boeslab
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Neurologist & Neuroscientist: Lesion Mapping | Lesion Network Mapping | Brain Stimulation
University of Iowa
Joined January 2022
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This is an amazing story – Krista and Tatiana Hogan are conjoined twin sisters with distinct personalities and *mostly* separate brains that are linked by a ‘thalamic bridge.’ They can use it as a portal to access the other’s sensations and feelings. 👇
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Tatiana doesn’t like ketchup and gets annoyed when Krista eats it because she will taste it too.
They can access visual information from the other's eyes and move the other’s limbs. Some modalities are apparently easier to access than others, with vision being more difficult.
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The individual with this precuneus lesion experienced a dramatic change in how he perceived the passage of time after surgery of a glioma.
Minutes felt like hours… each time he would check his watch he’d be surprised how little time had passed. 👇
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A white matter tract that takes 30 years to mature must be doing something important.
3 things to know about the uncinate fasciculus.
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"It's the damnedest thing. I haven't smoked since my stroke. Haven't had the desire to. I didn't even try to quit, it was like I forgot I was ever a smoker." - a few months after stroke involving left insula
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If they get into a fight the sting of a punch will be felt by both.
Their parents believe wordless conversations flow through this bridge too.
So many questions.... Could one wake the other up using thoughts alone? Could one eavesdrop while the other dreams?
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Does human consciousness rely on this tiny wisp of gray matter?
Claustrum anatomy and function 🧵
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Hi All, I'm brand new to Twitter. Could you help my lab and I get connected with the cognitive neuroscience community - neuroimaging, neuropsychology, lesion mapping, lesion network mapping, brain stimulation. I want to follow it all. Thanks!
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35 patients with precuneus lesions evaluated to date… here’s what we’re learning so far. 🧵
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There are a handful of video documentaries of these remarkable girls if you want to check it out.
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We see some strange and sometimes paradoxical effects of lesions to the default mode network.
A thread of some of the curious observations….
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...a lot of brilliant people on
#NeuroTwitter
. Maybe someone can explain why this otherwise healthy young woman with a thalamic stroke had visual hallucinations as the presenting symptom. Any new insights and I'll definitely consider my move to Twitter a success.
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Still in awe about this story... 29-year-old otherwise healthy woman has a massive stroke and loses half of her brain. Now, she's cognitively normal. Talk about plasticity. Amazing!
@MarkBowrenJr
Preserved Cognition After Right Hemispherectomy
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Arguably the most important white matter tract supporting human cognition.
5 things about arcuate fasciculus anatomy and an argument for its critical role in human cognition.
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It's so rare to see a focal stroke of the precuneus I thought I'd share this one. What do you think the neuro exam revealed
#NeuroTwitter
?
A) Inability to stay awake
B) Couldn't recall autobiographical information
C) Abnormal sensation of the hands
D) Delirium
See reply...
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Approaching 25 years since this gem was published. I'd argue it's the most original book on consciousness to date.
The idea that consciousness has evolutionary roots in the basic neural mechanisms that maintain homeostasis is still compelling.
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A fear center? A threat detection system?
What does the amygdala do?
🧵 on amygdala anatomy and function.
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Another good one for
#NeuroTwitter
to weigh in on… after this lesion, vision was no longer imbued with emotion. Even seeing a loved one elicited no emotion until other senses were engaged.
Any mechanistic insights?
Great case
@dbfisch
@PerezMGHLab
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What do you think
#Neurotwitter
: major change after a small midbrain hemorrhage centered on PAG?
A.New-onset panic attacks
B.Mind wandering more vivid & dream-like
C.Unable to cry, feel love
D.Resolution of chronic low back pain
Fascinating case from
@geerling_lab
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STN serves as the brain's primary pincushion for DBS.
But it has important and fascinating functions beyond that.
Subthalamic nucleus anatomy and function thread…
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What would you guess for a psychiatric presentation in an adolescent that we ultimately attributed to this focal congenital lesion?
A.Mania, multiple episodes without prior depression
B.Borderline personality disorder
C.Antisocial behavior
D.Somatic symptom disorder
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What would you guess for a major change after this surgical lesion of the left frontoinsular junction?
a)Difficulty switching from task to task
b)Sustained and effortless weight loss
c)Reduced ability to regulate emotion
d)Reduced awareness, as if life is on “autopilot”
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One of the most gratifying parts of lesion research is seeing results from these large group studies come to life in individual patients.
...recent paper from
@foxmdphd
@MoussawiKhaled
@shansiddiqi
@JJoutsa
and colleagues.
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What downstream targets does DLPFC TMS reach?
We set out to ask this question using intracranial EEG. 6.5 years later and I'm happy to *finally* share our first article using this approach in Molecular Psychiatry.
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A second person with a very similar lesion reported the same. There was a disorientation to time accompanied by a feeling like “time did not run.” It was even difficult to conceptualize what time was.
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Even if huge sample sizes are needed for brain-wide fMRI studies... we have solid complementary approaches that can lead to important insights with smaller n's. Much, much smaller! And these insights can constrain the anatomy for fMRI hypothesis testing. I think we'll be okay.
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Identifying the calcarine and parieto-occipital sulci in coronal view. A useful anatomical pearl in Hanna Damasio’s Lesion Analysis in Neuropsychology.
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Damage to this major occipitotemporal white matter tract can be associated with all except:
A) Inability to recognize faces
B) Inability to read
C) Monotone, emotionally flat speech
D) Lack of emotion to visual objects, including loved ones
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To unlock the potential of TMS as a treatment for brain disorders we need better tools to understand how it affects the brain. Our team has developed a new approach that is giving us a much better view. 4+ years later... our first paper. Check it out!
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@NickTrapp13
and our team evaluated depression symptoms in 526 people with focal brain lesions.
The 5 most important things we learned… 🧵
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We're seeing some interesting thalamic cases thanks to collaborator
@kaihwang12
's research program.
See if you can match the lesion with the syndrome...
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3. The functions are several-fold.
- episodic, memory,
- retrieval of names, semantic memory retrieval,
- valuation of social and emotional stimuli. A great review in Brain:
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C. When he brought his hands together while driving it didn't feel like they were "his" hands. He was alert, basic sensation was intact, opening a jar felt normal. Full neuropsych battery normal. Rt precuneus & agency and\or body ownership \ internal models.
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I'll go with Projections as my favorite neuro book of the last 5... maybe even 10 years.
@KarlDeisseroth
is amazing. Should be a lock for a Nobel prize and might be just as talented as a writer.
Curious what others on
#neurotwitter
recommend. Any
#FavoriteNeuroBooks
?
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A white matter lesion causes difficulty coming up with the names of items & frequent semantic errors. The responsible structure (red) is most likely…
A. Arcuate fasciculus
B. Inferior longitudinal fasc.
C. Inferior fronto-occipital fasc.
D. Superior longitudinal fasc.
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What's your guess... lesion symptom map results (N=234) showing an area where lesions are associated with:
A) insomnia
B) reduced depression and anxiety
C) thought disorder symptoms (self report, MMPI)
D) reduced appetite \ anorexia
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“Everything is blurry when I move my eyes…
Ever since my stroke it’s like my vision can’t keep up with my eye movements anymore.”
What’s going on here?
I’ll throw out an idea \ brief thread.
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What would you guess, most notable change after this brainstem lesion was…
A. New-onset hyper-awareness of heartbeat
B. Episodes of losing muscle tone with laughing (cataplexy)
C. Uncontrolled bursts of crying and laughter
D. Started acting out dreams
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Guess what MMPI personality scale is behind this lesion-symptom map?
A. Increased somatic complaints
B. Low positive emotions
C. Behavioral dysregulation
D. Ideas of persecution
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The DMN appears to afford us with a simulation superpower, self-insight, autobiographical memory, and the ability to think across time scales. Accompanied by an unfortunate proclivity to be used for negative rumination that can sour our mood and sully our outlook on life.
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Yes. We've definitely seen that. The patient from the image above felt his hands were no longer ‘his’ hands. This aligns with collaborator Guillaume Herbet et al showing anterior precuneus lesions alter bodily awareness.
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What is its most unique and important function? - UF is uniquely placed to facilitate information flow between the temporal pole, critical for stable cross-modal associations that underlie our conceptual knowledge of certain categories of information (e.g. linking a face to a..
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Surgery for temporal lobe epilepsy was associated with significantly improved mood, on average (N=52).
Mood was especially improved if the amygdala was resected.
New study by Fatimah Albazron and team.
PDF:
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1. UF is bidirectional, connecting the ventral frontal and anterior & medial temporal lobe.
Uncinate means ‘hook’ and the arch of the hook tracks along the temporal stem (red arrow) and is located just below the inferior fronto-occipital fasciculus (IFOF)...
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Delighted to announce that Dan Tranel will receive the 2024 U. of Iowa CCOM Distinguished Mentor Award.
Recognizing a lifetime (40+ years) of excellence in mentoring neuroscience and clinical psychology trainees, myself included.
@UIowaNeuro
@IowaNeurology
@IowaMed
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Also:
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My hunch is this new lesion connectome-predictive modeling approach by
@jfjiang
published yesterday in
@NatureComms
will become the next generation of lesion network mapping. Seems very promising at this early stage.
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First, as always, the anatomy.
The claustrum is a thin sheet of gray matter between the insula and the putamen.
It is enclosed by white matter - extreme capsule (insula side) and external capsule (putamen side).
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2. Catherine Lebel and others have shown it has a very long developmental trajectory, with DTI measures showing maturation through the first three decades of life.
Original:
Review:
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It was C. Very memorable patient for me that goes all the way back to my 3rd year of medical school. Perfect timing as I had just completed my PhD, thinking a lot about the vmPFC and its role in social behavior. Led to my first case report:
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DMN is located as far away from primary motor and sensory cortices as possible –anatomically buffered from external reality and perfectly positioned to support stimulus-independent thought… simulating situations, replaying events, planning, ruminating.
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The flow of information can help integrate concrete features of objects and their real-time fluctuations in value to guide action. This is especially salient in the social sphere; UF shows up frequently in association with abnormal social & antisocial behavior.
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It is the most densely connected structure in the brain by volume (Torgerson, 2014) - primarily topographic reciprocal connections with the cerebral cortex. 84% input from cortex.
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What do you guess
#Neurotwitter
– lingering issue a couple months after surgical resection of this dorsal anterior cingulate \ “salience” node?
A.New-onset insomnia
B.Fatigue \ excessive sleep
C.New-onset gambling addiction
D.Depressed mood
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voice to a name), and the orbitofrontal cortex (OFC), which in real-time can represent the value of an entity. The value of a slice of pizza changes over the course of a meal. The value of a relationship can change over the course of a evening out.
OFC:
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@JaxSkye
has shown that one’s sense of time can be dramatically altered following a lesion, the passage of minutes can feel like hours
Time thead:
Article under review, earlier version preprint here:
The individual with this precuneus lesion experienced a dramatic change in how he perceived the passage of time after surgery of a glioma.
Minutes felt like hours… each time he would check his watch he’d be surprised how little time had passed. 👇
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‘If all my life’s memories were playing cards ordered by time this stroke shuffled the deck’
Spouse: people thought she was making stuff up. She was talking about actual events, but they happened 20 years ago and she was talking as if they happened yesterday.
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Insula is Latin for island, which connotes detachment & isolation. It was a botched naming job in some respects, as the insula is an exceedingly well connected anatomical hub.
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Francis Crick, winner of a Nobel Prize for co-discovery of DNA structure, made his final scientific contribution from his death bed.
He boldly proposed the claustrum is integral to multisensory binding that underlies our perceptual experiences.
Did he and Koch get it right?
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It wasn't all positive though... mood took a nose dive and depression was a major concern.
Aligns with our new paper by
@NickTrapp13
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We hope to hire a post-doc to help with our TMS-intracranial EEG research, working with my lab
@IowaNeuro
, Nick Trapp, and
@DrCoreyKeller
@KellerStanfordU
. We have data on 20+ participants ready for analysis.
First preprint here:
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It has access to multi-modal sensory information to monitor the environment and the most comprehensive interoceptive map of the body, placing it in a powerful position to dynamically map environmental contexts to body states (real or simulated) and guide behavior accordingly.
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What does the newly discovered SCAN network do?
Interestingly, it was the main network implicated in pediatric lesion-induced dystonia
Thanks
@RoseGelineauMD
for leading this multi-site study. Great to see lesion work being done in pediatrics!
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Our lab is trying a new weekly ���Ode to Neuroanatomy’ session on Fridays. I’ll post some highlights here in case others want to follow along & sharpen your functional neuroanatomy skills.
The IFOF topic was thanks to Joseph Griffis.
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It makes me wonder - are these two very different types of outcomes independent? We'll have to keep it in mind as a possibility as we start thinking about neuromodulation of these circuits for addiction.
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What does it do? Here is a very good review, with some key proposed functions summarized in the image.
Human lesions and animal studies link the claustrum to perception, salience, sleep and pain
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It's official! So excited to welcome our newest faculty member Jing Jiang
@jingjiang_psy
to our UI neuro community. Coming by way of Harvard
@foxmdphd
& Stanford
@AmitEtkin
. Doing amazing work in social interaction, emotion regulation, & lesion network mapping. Give her a follow!
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The ability to orient yourself in time with reference to clocks and calendars relies on DMN regions (precuneus & medial temporal).
A 🧵on this topic from work that was accepted at Annals earlier this week. Huge congrats to
@jaxskye
, soon to be Dr. Skye
The individual with this precuneus lesion experienced a dramatic change in how he perceived the passage of time after surgery of a glioma.
Minutes felt like hours… each time he would check his watch he’d be surprised how little time had passed. 👇
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That is all for topic
#5
in our lab's Ode to Neuroanatomy series. Credit to
@NickTrapp13
. I'll take the blame for any unsubstantiated musings. 😆
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My best guess for the impaired executive function involves a role of the central precuneus in coordinating between task positive and spontaneous brain states.
But, it’s a work in progress. I’d love to hear some fresh insights from
#NeuroTwitter
. What've you got?
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Auditory masking of TMS has a clear beneficial effect.
Cleans artifact signal in primary auditory cortex, as one would expect, but also changes the iEEG response in other brain areas.
Out today in
@brainstimj
by
@NickTrapp13
, Eric Tsang and team.
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1 cont. It is sandwiched between the insula (I) (ventral anterior portion) and putamen (P) on either side. In the prefrontal cortex it spans out, with fibers reaching the ventral lateral surface (inferior frontal gyrus) and medial surface.
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Is the wakefulness-promoting, consciousness-enabling influence of the brainstem left-lateralized in humans?
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It is helpful to think of its 3D relationship with the hippocampus as an arm-hand holding a basketball, best appreciated in sagittal.
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#3
) Anterior Division: The dorsal anterior insula is a core node of the cingulo-opercular \ action motor network. It has a strong functional connection to the dorsal ACC. A fantastic article on that network by
@ndosenbach
here:
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It was C. Overall blunted experience of emotion with these two examples standing out to me. Things that should have felt emotional lost their affective punch. An exception was anger, which could be provoked more easily.
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The dorsal attention network has a critical role in supporting g, based on lesion data from >500 individuals
Another important paper in the works by
@MarkBowren
.
And a Best Poster Award at
#ANPA2023
to boot.
Congratulations Mark. Way to represent
@UIowaNeuro
! 🔥
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A shout out to
@andreashorn_
for his new podcast . It is outstanding.
Thoughtful, insightful interviews with so many luminaries in the field. I just learned of it last week and I'm loving it. Check it out
@stimbrains
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#6
) There are some wonderful papers and books that propose more unifying frameworks describing insular functions.
Four of my absolute favorites:
Saliency, switching, attention and control: a network model of insula function
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So what does it do? These are early findings and we're just barely scratching the surface here. At a minimum it processes integrated maps representing the body and some more abstract, conceptual entities like time in a way that is accessible to conscious awareness.
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#5
) Laterality. We see lateralized insula effects in many of our lesion analyses. We're seeing the right is critical for affective decision making, self-insight, neglect, personality. The left is implicated in speech and executive function. Bilateral for addiction and depression
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The ability to recall autobiographical details of your life is impaired.
Work by
@CarissaP2
"Damage to the default mode network disrupts autobiographical memory retrieval"
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A landmark day for using TMS to treat depression.
Also the first instance of an FDA cleared method of using fMRI to guide personalized TMS targeting. Hopefully the first of many. Congrats
@NolanRyWilliams
and team!
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2.
3.
4.
5.
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Mood is often improved after DMN lesions.
Not only relative to people with brain lesions but also relative to published norms from the general population matched for age.
🧵on this work from
@NickTrapp13
's recent
@Brain1878
article:
@NickTrapp13
and our team evaluated depression symptoms in 526 people with focal brain lesions.
The 5 most important things we learned… 🧵
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But it’s not all bad. What might be considered paradoxical and actually an improvement…
Mind wandering is reduced.
Also from
@CarissaP2
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#3
cont) The dorsal node is thought to be more action oriented and involved in cognitive control, shifting attention while the ventral node is more implicated in homeostasis and mood states - involvement in early behavioral variant FTD helps in thinking of its functional role.
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The shape and location are perfectly situated for the human claustrum to remain an enigma for a very long time.
Focal lesions are exceptionally rare and it is thin enough that it evades most conventional imaging research.
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What does interception have to do with decision making?
The somatic marker hypothesis and the possible functions of the prefrontal cortex
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So what happens when it is lesioned? Cognitive performance tends to be preserved. Full scale IQ is often normal. You can see this in Warren 2014, blue profile.
DMN nodes often appearing in our analyses as associated with a lack of impairment on attention demanding tasks.
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No doubt this is just a small fraction of the fascinating lesion work happening with the DMN, mostly from the Iowa Lesion Registry
@UIowaNeuro
.
What am I missing? What else have you got,
#NeuroTwitter
?
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