Behavioural expression of ictal embarrassment: a stereo-EEG case report.
5 affiliations
- 1"Claudio Munari" Epilepsy Surgery Center, ASST Niguarda Hospital, Milan, Italy.
- 2DIBINEM, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
- 3Epilepsy Program, IRCCS Istituto Delle Scienze Neurologiche di Bologna, European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy.
- 4Neurology Unit, University Hospital of Pisa, Pisa, Italy.
- 5Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France.
Abstract
Embarrassment is a rare ictal manifestation whose neurophysiological basis remains poorly understood. We describe the case of a 40-year-old woman with drug-resistant focal epilepsy characterized by an unusual ictal semiology combining an intense positive emotional experience with behavioral manifestations of embarrassment. Stereo-EEG demonstrated seizure onset within the middle frontal gyrus bank of the superior frontal sulcus (F2sb), with rapid propagation to the dorsal anterior cingulate cortex (dACC) and superior anterior insula (sAI). Electrical stimulation of the F2sb reliably reproduced the habitual electroclinical seizure. While identical stimulation parameters elicited the subjective and autonomic manifestations in both supine and upright postures, the complete behavioral repertoire of embarrassment emerged only when stimulation was delivered in the standing position. Exploratory functional connectivity analyses revealed that overt embarrassment was associated with reduced node strength within a network encompassing the dACC, sAI, mesial prefrontal cortex (mPFC), and dorsolateral prefrontal cortex (dlPFC). More restricted network changes were associated with only mild sensations, whereas asymptomatic stimulation produced a distinct and partly reversed connectivity pattern. This case suggests that the behavioral expression of ictal embarrassment arises from the transient reconfiguration of a frontal-cingulo-insular network and is critically shaped by bodily context.
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BibTeX
@article{scarabello2026behavioural,
title = {{Behavioural expression of ictal embarrassment: a stereo-EEG case report.}},
author = {A Scarabello and V Pelliccia and F Bisulli and M Revay and F Gozzo and A Mingarelli and C Peretto and R Mai and C Pizzanelli and F Pizzo and F Bartolomei and L Tassi},
journal = {Frontiers in human neuroscience},
year = {2026},
month = oct,
doi = {10.3389/fnhum.2026.1951958},
url = {https://europepmc.org/article/MED/42903233},
note = {CC BY},
}
RIS
TY - JOUR
TI - Behavioural expression of ictal embarrassment: a stereo-EEG case report.
AU - A Scarabello
AU - V Pelliccia
AU - F Bisulli
AU - M Revay
AU - F Gozzo
AU - A Mingarelli
AU - C Peretto
AU - R Mai
AU - C Pizzanelli
AU - F Pizzo
AU - F Bartolomei
AU - L Tassi
PY - 2026
DA - 2026/10/06
JO - Frontiers in human neuroscience
DO - 10.3389/fnhum.2026.1951958
UR - https://europepmc.org/article/MED/42903233
AB - Embarrassment is a rare ictal manifestation whose neurophysiological basis remains poorly understood. We describe the case of a 40-year-old woman with drug-resistant focal epilepsy characterized by an unusual ictal semiology combining an intense positive emotional experience with behavioral manifestations of embarrassment. Stereo-EEG demonstrated seizure onset within the middle frontal gyrus bank of the superior frontal sulcus (F2sb), with rapid propagation to the dorsal anterior cingulate cortex (dACC) and superior anterior insula (sAI). Electrical stimulation of the F2sb reliably reproduced the habitual electroclinical seizure. While identical stimulation parameters elicited the subjective and autonomic manifestations in both supine and upright postures, the complete behavioral repertoire of embarrassment emerged only when stimulation was delivered in the standing position. Exploratory functional connectivity analyses revealed that overt embarrassment was associated with reduced node strength within a network encompassing the dACC, sAI, mesial prefrontal cortex (mPFC), and dorsolateral prefrontal cortex (dlPFC). More restricted network changes were associated with only mild sensations, whereas asymptomatic stimulation produced a distinct and partly reversed connectivity pattern. This case suggests that the behavioral expression of ictal embarrassment arises from the transient reconfiguration of a frontal-cingulo-insular network and is critically shaped by bodily context.
SN - 1662-5161
ER -