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A fast pathway for fear in human amygdala


Constantino Méndez-Bértolo1,2,10, Stephan Moratti1,3,4,10, Rafael Toledano5, Fernando Lopez-Sosa1,
Roberto Martínez-Alvarez6, Yee H Mah7, Patrik Vuilleumier8, Antonio Gil-Nagel5 & Bryan A Strange1,9
A fast, subcortical pathway to the amygdala is thought to have evolved to enable rapid detection of threat. This pathway’s
existence is fundamental for understanding nonconscious emotional responses, but has been challenged as a result of a lack
of evidence for short-latency fear-related responses in primate amygdala, including humans. We recorded human intracranial
electrophysiological data and found fast amygdala responses, beginning 74-ms post-stimulus onset, to fearful, but not neutral
or happy, facial expressions. These responses had considerably shorter latency than fear responses that we observed in visual
cortex. Notably, fast amygdala responses were limited to low spatial frequency components of fearful faces, as predicted by
magnocellular inputs to amygdala. Furthermore, fast amygdala responses were not evoked by photographs of arousing scenes,
© 2016 Nature America, Inc. All rights reserved.

which is indicative of selective early reactivity to socially relevant visual information conveyed by fearful faces. These data
therefore support the existence of a phylogenetically old subcortical pathway providing fast, but coarse, threat-related signals
to human amygdala.

A classical model of emotional responses in the brain 1 holds that were also implanted in visual cortical areas, thereby enabling direct
the amygdala receives direct subcortical inputs through the supe- comparison of latencies to emotional versus neutral face responses
rior colliculus and pulvinar2, which enables crude, but rapidly proc- in amygdala and ventral visual cortex.
essed, information about fear-related cues to bypass detailed cortical In experiment 1, intracranial event-related potentials (iERPs) were
processing in visual pathways3. This ‘low-road’ model for fear process- recorded while patients judged the gender of BSF, LSF and HSF faces
ing is based primarily on rodent data1. Evidence for a fast pathway displayed on-screen for 500 ms. Patients viewed 135 faces, each of
in humans has only been inferred indirectly from neuroimaging which was ‘identity unique’, that is, faces pertained to 135 different
studies in healthy individuals4,5 that used subconscious emotional actors, balanced for gender. The procedure was repeated after a 10-min
stimulus presentation during functional magnetic resonance imaging break (the same stimuli were presented in different random order). We
(fMRI)6,7 and in cortically blind patients who showed preserved expected that fast amygdala responses would occur for phylogenetically
processing of unseen visual fear-related stimuli8,9, possibly medi- ‘prepared’ stimuli22, such as faces, and not for more complex emotional
ated by intact fiber connections between pulvinar, superior colliculus stimuli, such as arousing scenes. Thus, in a second experiment, we
and amygdala10, after damage to visual occipital areas. However, recorded iERPs while patients viewed complex neutral and unpleasant
given a lack of direct electrophysiological evidence for short-latency arousing scenes and performed indoor-outdoor judgments. Electrode
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fear-related responses in human amygdala11–14, an alternative to the contacts in amygdala and visual areas were localized by co-register-
low-road model suggests that some cortical regions may be equally ing each patient’s pre-operative structural MRI with their post-opera-
fast at processing fear as the amygdala15,16. tive computed tomography (CT) scan (Fig. 2a and Supplementary
We addressed this controversy by presenting emotional (fearful, Figs. 1 and 2). By recording from 19 patients with amygdala electrodes,
happy) and neutral faces to patients with medication-resistant epi- we found very early latency iERPs in human amygdala to fearful, but
lepsy in whom stereotactic electrodes had been implanted in the amy- not happy or neutral, faces that preceded the earliest iERPs observed in
gdala for pre-surgical evaluation. The faces were presented either as face-sensitive fusiform gyrus. As predicted, the fast amygdala response
normal photographs (broad spatial frequency, BSF) or were spatially was selectively observed to the low SF component of fearful faces,
filtered such that only their low (LSF) or high (HSF) spatial frequency and was not evoked by complex unpleasant scenes.
components were displayed (Fig. 1). Because subcortical pathways
are thought to carry only crude (LSF) visual input to the amygdala RESULTS
via magnocellular neurons17–21, we hypothesized that rapid amygdala Fast amygdala responses to fearful faces
responses to fearful faces would be restricted to those containing LSF In experiment 1, we tested 16 patients with amygdala electrodes,
information (that is, LSF and BSF faces). In some patients, electrodes of whom eight satisfied our inclusion criteria (two right, four left

1Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Technical University of Madrid, Madrid, Spain. 2CEI Campus Moncloa, UCM-UPM, Madrid,

Spain. 3Department of Basic Psychology I, Complutense University of Madrid, Madrid, Spain. 4Laboratory for Cognitive and Computational Neuroscience, Centre
for Biomedical Technology, Technical University of Madrid, Madrid, Spain. 5Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain.
6Department of Neurosurgery, Hospital Ruber Internacional, Madrid, Spain. 7Neuroscience Research Centre, Cardiovascular and Cell Sciences Institute, St. George’s,

University of London, London, UK. 8Laboratory for Neurology and Imaging of Cognition, Department of Neuroscience and Neurology, University Hospital and Medical
School, University of Geneva, Geneva, Switzerland. 9Department of Neuroimaging, Reina Sofia Centre for Alzheimer’s Research, Madrid, Spain. 10These authors
contributed equally to this work. Correspondence should be addressed to B.A.S. (bryan.strange@upm.es).

Received 3 March; accepted 12 May; published online 13 June 2016; doi:10.1038/nn.4324

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Fearful Happy Neutral the onset of iERPs that were significantly different from zero for each
stimulus type separately for the entire post-stimulus period. Notably,
significant fast-latency effects, beginning ~70 ms post-stimulus presen­
BSF
tation, were limited to BSF and LSF fearful face responses (for BSF
fearful faces, from 72–118 ms at cluster threshold P < 0.01, summed
t value = −73.20; P = 0.023, and from 68–194 ms at cluster threshold
P < 0.05; for LSF fearful faces from 72–146 ms at cluster threshold
P < 0.01, summed t value = −124.82; P = 0.013, and from 66–192 ms
at cluster threshold P < 0.05; Fig. 2g and Supplementary Table 5).
HSF

Next, given that we recorded from four right and six left hemi-
sphere amygdalae, we separated iERPs as a function of hemisphere
(Supplementary Fig. 3). A fast deflection is seen for fearful faces in
both left and right amygdala. To test for a laterality effect on the time
window expressing an emotion by SF interaction (76–110 ms), we
LSF

entered mean amplitude differences across this time window for each
emotion contrast, collapsing across BSFs and LSFs, into a Kruskal-
Wallis test comparing right versus left amygdalae. Although the mag-
Figure 1  Experimental face stimuli. Examples of BSF, LSF and HSF faces nitude of the fast fear response appeared larger for right amygdala
with fearful, happy and neutral expressions presented in experiment 1.
(Supplementary Fig. 3), consistent with right-lateralized amygdala
Note that each stimulus was identity unique (that is, a different actor for
each of the 135 faces presented). responses to fearful faces in cortically blind patients8, we observed no
significant laterality effects (right versus left amygdalae tests for fearful
© 2016 Nature America, Inc. All rights reserved.

minus neutral χ2(1) = 2.23, P = 0.136; fearful minus happy χ2(1) = 0.73,
and two bilateral; Table 1, Fig. 2a,b and Supplementary Table 1). P = 0.394; happy minus neutral χ2(1) = 0.05, P = 0.831).
Providing direct support for the low-road model of fear detection, our
amygdala recordings revealed a prominent fast deflection for fearful Later latency amygdala responses to emotional faces
faces that was different from that for both happy and neutral faces The early effects that we observed contrast with previous reports
as early as 74 ms post-stimulus (Fig. 2c). Cluster-based permutation of rather late (200 ms) intracranially recorded human amygdala
testing23 using multivariate analysis of variance (MANOVA) with responses to fearful faces12 or complex emotional scenes11. Here, the
within-subject factors of emotion (fearful, happy, neutral) and spatial emotion (fearful, happy, neutral) by SF (BSF, HSF and LSF) cluster-
frequency (SF) (broadband, HSF, LSF) was applied to all post-stimulus based permutation MANOVA test with a less conservative cluster
time points. A time cluster expressing a significant emotion by SF threshold of P < 0.05 also revealed a relatively early main effect of
interaction was observed between 76–110 ms after face presentation emotion in two time clusters: between 106–144 and 148–204 ms, and
(at cluster threshold P < 0.01; summed F value = 455.89, P = 0.001), 282–302 ms. At cluster threshold P < 0.01, only two clusters (between
which extended between 74–122 ms at a more liberal cluster threshold 158–162 and 184–200 ms) showed a main effect of emotion (Fig. 2c
of P < 0.05 (Fig. 2c and Supplementary Table 2). and Supplementary Table 2). Post hoc t tests (Supplementary Table 6)
Given our prior hypothesis that fast, fear-specific responses in revealed that, irrespective of frequency, in clusters prior to 200 ms,
human amygdala arise via a magnocellular pathway, planned com- responses to fearful faces were greater than those to both neutral and
parisons on iERP amplitudes across the interaction time cluster were happy faces, but, in the late time window (288–302 ms), fearful face
performed to directly test for fear-specific early responses restricted responses were only greater than those to neutral faces.
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to BSF and LSF faces. Thus, a set of four linear contrasts were com-
puted, and ensuing P values were corrected for false discovery rate Effect of repetition on amygdala responses
(Pfdr) for these four tests. Testing responses to fearful versus happy Previous iERP recordings have shown habituation of amygdala
and neutral faces (fearful ≠ (happy = neutral)) at each SF revealed a responses with multiple repetitions of emotional face presenta-
significant effect for BSF and LSF, but not HSF, faces for the 76–110- tion12, which may, in those recordings, have obscured a fast amy-
ms window (BSF: F1,9 = 12.22, P = 0.007, Pfdr = 0.016; LSF: F1,9 = 9.55, gdala response. To safeguard against habituation effects, we presented
P = 0.013, Pfdr = 0.017; HSF: F1,9 = 2.72, P = 0.133, Pfdr = 0.133). each patient with 135 identity-unique faces that were repeated only
Responses to BSF and LSF fearful faces were therefore significantly once in a second block. Nonetheless, to specifically verify repetition
different from responses to neutral and happy faces in this time win- effects on amygdala iERPs in our procedure, we performed an addi-
dow (Fig. 2d), with this negative deflection to BSF and LSF fearful tional MANOVA for the mean amplitude across the early interaction
faces being observed in eight of the ten amygdalae recorded (Fig. 2e time window (76–110 ms), including a within-subject factor ‘block’.
and Supplementary Table 3). Furthermore, short-latency amygdala We observed no emotion by SF by block interaction (F4,6 = 0.71,
responses to BSF and LSF fearful faces were significantly different to P = 0.615) for responses in the early latency interaction window,
those elicited by HSF fearful faces (fearful HSF ≠ (fearful BSF = fearful or a block by emotion (F2,8 = 0.16, P = 0.853) or frequency by block
LSF)) (F1,9 = 11.51, P = 0.008, Pfdr = 0.016). Thus, amygdala responses (F2,8 = 1.90, P = 0.211) interaction. Only an emotion by frequency
to BSF and LSF fearful faces did not differ, but were both significantly interaction (F4,6 = 19.15, P = 0.001) was significant (equivalent
different from HSF fearful face responses (post hoc t tests compar- tests for later time windows expressing main effects of emotion and
ing iERP amplitudes across the interaction time cluster; Fig. 2f and frequency are given in Supplementary Table 7).
Supplementary Table 4). Altogether, these data indicate a selective
fast amygdala response to the LSF components of fearful faces. Fearful face responses are localized to lateral amygdala
To determine the onset of deflections to each face stimulus type The amygdala comprises several subnuclei, and the lateral component
individually, we applied cluster-based permutation statistics to test for is considered to be the sensory gateway to the amygdala1. Our iERP

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Figure 2  Fast-latency human amygdala a L R


b L R
responses to BSF and LSF fearful faces. Patient 03 (R)
Anterior
(a,b) Schematic summary of electrode contact Patient 04 (L)
localizations in left and right amygdala for all Patient 05 (L)
Patient 06 (B)
patients included in experiment 1 are displayed Patient 10 (R)
(color coded) on serial coronal sections of the Patient 15 (L) Posterior
MNI canonical T1 image (anterior-posterior y=0
Patient 16 (B)
Patient 25 (L) Lateral Medial Medial Lateral
position indicated by y coordinates; a) and
semi-transparent segmented amygdalae c 40
(b) as viewed from above. (c) Amygdala Fearful
Happy
iERPs from ten amygdalae of eight patients y = –2 20 Neutral
(total of 26 contacts) to fearful, happy and

Amplitude (µV)
neutral faces collapsed over spatial frequencies
0
and averaged. Horizontal bars below depict
y = –4
time clusters expressing a significant main
effect of emotion (top) or SF (middle), or a –20 Emotion
significant interaction between both (bottom) Frequency
Interaction
using a cluster threshold of P < 0.05 (gray) y = –6 –40
–100 0 100 200 300 400 500 600
or P < 0.01 (black) on cluster-based non-
parametric permutation statistic, based on d 40
Fearful
e 60
MANOVA F values (Supplementary Table 2). Happy
An emotion by spatial frequency interaction 20 Neutral
Amplitude (µV)

was observed from 74–122 ms post-stimulus

Amplitude (µV)
onset (at cluster threshold P < 0.05; from 0
© 2016 Nature America, Inc. All rights reserved.

76–110 ms at cluster threshold P < 0.01).


0
A significant main effect of emotion was
–20
observed in time clusters from 106–144 ms, Time (ms)
148–204 ms and 282–302 ms, and main effect
–40
of spatial frequency from 308–334 ms (all at –100 0 100 200 300 400 500 600 –30 76–110 ms 282–302 ms
cluster threshold P < 0.05). At cluster
threshold P < 0.01, a significant main effect f 40
BSF fearful g 0 100 200 300 400 500 600
HSF fearful Time (ms)
of emotion is observed during two clusters 20 LSF fearful BSF fearful
at 158–162 ms and 184–200 ms. Shaded
Amplitude (µV)

HSF fearful
area indicates s.e.m. (d) Amygdala iERPs to LSF fearful
0 BSF happy
emotional and neutral faces, collapsed over
HSF happy
BSF and LSF only. (e) Dot plots of responses to
LSF happy
fearful faces, collapsed over BSF and LSF, of –20
BSF neutral
the ten individual amygdalae during the early HSF neutral
interaction (left) and the late main effect of –40 LSF neutral
–100 0 100 200 300 400 500 600
emotion (right) time windows (Supplementary
Table 3). Each amygdala is represented by a triangle, with orientation (left or right pointing) indicating left or right amygdala, respectively. Color coding
is depicted as in a; note that patients 6 and 16 were implanted bilaterally. Dot plots are superimposed on mean activity across all amygdalae (error bars
indicate s.e.m.). (f) Amygdala iERPs to fearful BSF, LSF and HSF faces. (g) Horizontal bars depict time windows in which responses to each stimulus
type are significantly different from zero with a cluster threshold of P < 0.05 (gray) or P < 0.01 (black) on cluster-based non-parametric permutation
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statistic, based on one-sample t test (Supplementary Table 5).

analyses collapsed over contacts that were anatomically limited to early and late fear responses in lateral amygdala could instead be
the amygdala, but spanned its medial-lateral extent (Fig. 2a,b). To consistent with different afferent inputs in the same neural popula-
refine the anatomical origin of the amygdala iERPs that we observed, tion. Also note that including responses from all amygdala electrode
we next performed a source localization analysis. For each patient, contacts (both in and outside the amygdala), and demonstrating
the minimum norm was applied to average responses to BSF and current source in lateral amygdala, eschews the possibility that iERPs
LSF fearful faces from all contacts (in and outside the amygdala) of are conducted from brain areas outside of the amygdala.
each amygdala electrode to obtain mean current source densities for
the time windows of the early interaction (76–110 ms) and late main Emotional face responses in ventral visual cortex
effect of emotion (282–302 ms) (Fig. 3a). For patient 10, source locali- The demonstration of SF-selective, fast-latency amygdala responses
zation was not possible, as seven of ten channels displayed a flat signal. to fearful faces does not exclude the possibility that, for the same
An overlap of thresholded source localizations (50% of peak activity) stimuli, similar latency responses are present in visual cortical areas
of the remaining patients revealed consistent localization of responses that provide input to the amygdala. To address this, we analyzed corti-
to lateral amygdala during the early interaction time window (eight cal responses in patients who also had electrode contacts in ventral
of nine amygdala responses; Fig. 3b). Source estimation was less visual areas. Seven of the patients that completed experiment 1 had
consistent for the late positive-going main effect of emotion (six of undergone electrode implantation in both amygdala and ventral visual
nine amygdala responses; Fig. 3b). However, both source localiza- cortex, and met all inclusion criteria. The primate amygdala receives
tions of time intervals for early negative-going and late positive-going extensive input from uni- and multi-modal areas of the temporal
waveforms overlapped substantially in lateral amygdala (Fig. 3c). The lobe24–26, but there is no evidence for amygdala afferents from the
latter observation is interesting, as the polarity inversion between occipital lobe24,25. We therefore focused our analyses on five patients
early and late responses may indicate recruitment of different with electrodes with contacts in fusiform gyrus (Fig. 4a), a face-
neuronal populations. However, spatially overlapping source localized sensitive region of the inferior temporal lobe27. Two of these patients

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Table 1  Patient demographic and clinical data

1044
Age at Percentage of Percentage of
onset Seizure trials with epileptic trials with epileptic
Experi- Hand- Age of epilepsy type (frequency Drugs and Education spikes in amygdala spikes in amygdala
Patient ment Sex edness (years) (years) Aetiology Lesion location per months) dose (mg) VIQ PIQ completed (experiment 1) (experiment 2)
02 2 F R 38 21 Hippocampal sclerosis Right hippocampal sclerosis plus porencephalic Weekly CPS LCS 400 103 91 Tertiary NA 0.3%
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plus focal dysplasia cyst over the parieto-occipital junction LEV 3,000
03 1 M R 55 21 Focal dysplasia Right temporal neocortex Monthly CPS PHT 200 132 125 Tertiary 10.6% NA
04 1 and 2 F R 21 12 Focal dysplasia Extensive lesion over the left frontal region Daily CPS CBZ 600 86 80 Tertiary 0.7% 21.7%
involving dorsolateral and orbitofrontal cortex Daily SPS CNZ 3.5
and anterior order of the cingulum LEV 1,500
TOP 400
05 1 and 2 M R 29 16 Periventricular Bilateral occipital horn heterotopia plus focal Weekly CPS CBZ 1,000 64 73 Secondary 2.6% 0.3%
heterotopia plus focal dysplasia over the left occipital cortex Daily SPS TOP 400
cortical dysplasia
06 1 and 2 M R 49 14 Hippocampal sclerosis Left hippocampal sclerosis Weekly CPS LGT 200 115 86 Tertiary Left 0% Left 0%
Monthly SG TCS CLB 30 Right 0% Right 0%
LCS 300
08 2 F R 29 8 months Focal dysplasia Extensive right posterior dysplasia involving Monthly CPS LEV 2,000 67 71 Secondary NA 10.6%
the convexity and medial aspect of parietal, LTG 500
occipital and posterior temporal lobes
10 1 M R 59 26 Encephalocele plus Right anterior temporal pole and basal area Weekly CPS PGL 375 105 102 Tertiary 3% NA
focal cortical dysplasia Encephalocele confirmed at surgery Monthly SG TCS ECZ 1,600
13 2 F R 42 16 Focal dysplasia Right basal temporal cortex Monthly CPS PGL 450 87 88 Secondary NA 10.6%
LCS 400
15 1 and 2 F R 35 16 Focal dysplasia Left temporal pole Daily CPS OXC 1,200 97 98 Tertiary 0.4% 0%
Weekly SG TCS PHT 150
16 1 and 2 M R 30 14 Reactive gliosis, Medial wall of the left parietal region Daily CPS LCS 400 102 93 Tertiary Left 1.5% Left 0.8%
diffuse microglia (precuneus and posterior cingulum) 4 SG TCS yearly ECZ 800 Right 1.1% Right 0%
activation and small LTG 300
vessel vasculopathy VAL 300
CLB 20
ESC 20
25 1 and 2 M R 29 13 Focal dysplasia Right posterior temporobasal region Weekly CPS CBZ 1,200 116 97 Tertiary 6.7% 5.8%
Monthly SG TCS LEV 1,000
LTG 200
ESC 10
CBZ, carbamazepine; CLB, clobazam; CNZ, clonazepam; CPS, complex partial seizure; ECZ, eslicarbazepine; ESC, escitalopram; LCS, lacosamide; LEV, levetiracetam; LTG, lamotrigine; NA, Not applicable; OXC, oxcarbazepine;
PGL, pregabalin; PHT, phenytoin; PIQ/VIQ, Procedural/Verbal Intelligence Quotient of the Wechsler Adult Intelligence Scale, version III (WAIS-III); SG TCS, secondary generalized tonic clonic seizure; SPS, simple partial seizure;
TOP, topiramate; VAL, valproate.

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a b c
Patient 16 76–110 ms 282–302 ms
y = –24 y = –25 y = –25

L R

pAm N 76–110 ms 282–302 ms


50 100 150 200 5 6 7 8

Figure 3  Amygdala iERPs to fearful faces originate from lateral amygdala. (a) Source localization of the response to BSF and LSF fearful faces in
the early time window (76–110 ms) from a representative amygdala (left amygdala of patient 16, 11 contacts). The current source map (thresholded
at 50% of maximum activity) is overlaid on a coronal section of the pre-operative T1 MRI from patient 16. The amygdala electrode is illustrated
schematically (white stripes represent amygdala contacts used for source localization; the black stripe is a bad channel with no signal). The color
bar indicates estimated current source strength in picoamperes (pA). (b,c) Group source localization maps for seven patients with nine amygdala
electrodes (total of 56 contacts in and outside the amygdala). (b) Co-incidence maps of voxels that show the number of source localization cases (N),
normalized to MNI space, that reached 50% of maximum activity, overlaid on two coronal sections of the canonical MNI (anterior-posterior locus
of each section is given by the y coordinate above). The color bar indicates the number of overlapping cases for the early interaction (left section,
MNI coordinates of: x = –26; z = –22; y = –4) and the later (282–302) main effect of emotion (right section, peak overlap: x = –26; z = –26;
y = –4) time windows. Note that right amygdalae source solutions were flipped to be overlaid onto the left amygdala for representation purposes.
© 2016 Nature America, Inc. All rights reserved.

(c) The co-incidence maps for both time windows in b have been thresholded at N ≥ 6 and superimposed to show that they overlap in lateral inferior
amygdala. The inset depicts a magnified view of the amygdala region.

had two different electrodes in fusiform gyrus, yielding seven groups P < 0.05), earlier than previously reported iERP latencies to fearful
of fusiform contacts. In a first analysis, we determined an index of versus neutral faces recorded in ventral visual cortex (~300 ms) 12,
face-selectivity for these fusiform contacts by comparing responses but, notably, 100 ms later than the effects observed in the amygdala.
to broadband neutral faces relative to neutral scenes (presented in No earlier emotion or interaction effects were observed at either clus-
experiment 2, described below). One fusiform contact group was ter threshold (Supplementary Table 8). We observed main effects
excluded from this analysis because of a signal artifact in experiment 2 of SF (two clusters spanning 202–284 ms at both cluster thresholds,
(Fig. 4a); thus, iERPs from six contact groups were compared at the and a separate cluster from 170–186 at cluster threshold P < 0.05)
group level using cluster-based permutation analysis. This analysis, followed by an emotion by SF interaction around 300 ms at both
comparing all post-stimulus time points, revealed a significant cluster cluster thresholds (Supplementary Tables 8 and 10).
between 164–176 ms (summed t values = −32.07, P = 0.03), suggest- Recording from both amygdala and face-sensitive fusiform cor-
ing a selective fusiform response to faces versus scenes at a latency tex enabled a comparison of fear-evoked responses between these
consistent with the face-sensitive N170 potential28 (Fig. 4b). areas. Thus, in the four patients with electrodes in both amygdala
We next examined the interaction between emotional facial expres- and fusiform cortex, we compared emotional face responses between
sion and SF in the iERPs recorded from the seven groups of fusiform these two areas in the early emotion by SF interaction time window.
contacts during experiment 1. Group-averaged fusiform responses to The mean amplitude difference between emotions (fear versus happy,
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face stimuli (Fig. 4c) were characterized by a positive peak at ~120 ms fear versus neutral, and happy versus neutral) across the 76–110-ms
post-stimulus onset, followed by a negative deflection peaking at 170 ms window, collapsing over BSF and LSF, was calculated for both the
and then a slower positive component. Cluster-based permuta- amygdala and fusiform gyrus, separately. These six difference val-
tion testing employing an emotion (fearful, happy, neutral) by SF ues (three emotion differences for amygdala and fusiform contacts,
(BSF, HSF, LSF) MANOVA showed only a main effect of frequency respectively) for each of the four patients were entered into a Friedman
from 206–240 ms at cluster threshold P < 0.01 (Supplementary test. This test showed a significant interaction between emotion and
Table 8). Post hoc tests in this time window revealed that, although brain region (χ2(5) =12.71, P = 0.026). Further Friedman tests for each
responses to broad and LSF faces were greater than to HSF faces, region separately revealed a significant emotion effect in amygdala
broad and LSF responses did not differ (Supplementary Table 9), (χ2(2) = 8, P = 0.018) but not in fusiform (χ2(2) = 2, P = 0.368).
reflecting later latency negative deflections to HSF faces relative to It remains possible, however, that fast afferent input from fusiform
BSF and LSF (Fig. 4d). In contrast with effects observed in the amy- cortex arrives at the amygdala before a differential response to fear-
gdala, we did not observe a significant interaction at early latencies, ful versus neutral or happy faces is observed in the fusiform, that
even after relaxing the cluster threshold to P < 0.05 (Supplementary is, emotion selectivity arises in the amygdala, but still depends on
Table 8). At this lower threshold, the earliest observed effects were up-stream fusiform activity. Given that fast amygdala responses are
a main effect of frequency from 204–258 ms followed by an emo- observed to BSF and LSF fearful faces, we next tested for the earliest
tion by SF interaction from 290–334 ms (Supplementary Table 9). onset of any upward or downward deflection in fusiform contacts to
To our surprise, no significant main effect of emotion was obtained. BSF and LSF fearful faces, adopting a liberal statistical approach: we
However, given that enhanced fusiform responses were observed less employed a one-tailed t test against zero for each time point of the
frequently to happy than to fearful faces29, we repeated this analysis, entire post-stimulus period, applying an uncorrected alpha level of
comparing only fearful and neutral stimuli (Fig. 4e). This analysis 0.05 (Fig. 4f). The first significant deflection for BSF fearful faces
yielded a significant main effect of emotion in a 172–218 ms time was negative and spanned 174–192 ms (174 ms: t6 = −2.53, P = 0.044
cluster (summed F values, 229.44; P < 0.001, at cluster threshold uncorrected); for LSF fearful faces there was a significant positive

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a Fus1 Patient 13 b 80
Faces
Scenes
c 80
Fearful
Happy
Fus2 Patient 15 Neutral

Amplitude (µV)
40

Amplitude (µV)
40
Fus3 Patient 10
Fus4 Patient 03 0 0

Fus5 Patient 13 –40 –40


Fus6 Patient 05* Emotion
–80 Time (ms) –80 Frequency
R L Fus7 Patient 03 Interaction
–100 0 100 200 300 400 500 600 –100 0 100 200 300 400 500 600

d 80
BSF e 80 Fearful f 80
BSF fearful
HSF fearful
HSF Neutral
LSF LSF fearful
Amplitude (µV)

Amplitude (µV)

Amplitude (µV)
40 40 40

0 0 0

–40 –40 –40


Emotion
–80 –80 Frequency –80
Interaction
–100 0 100 200 300 400 500 600 –100 0 100 200 300 400 500 600 –100 0 100 200 300 400 500 600

g
Figure 4  Fast responses to fear are not observed in fusiform gyrus. (a) Summary illustration of contact sites in the fusiform 80
gyrus, depicted as colored shapes, and superimposed on a semi-transparent MNI template brain. Different groups of contacts

Amplitude (µV)
40
from the same patient are displayed in the same color. The asterisk indicates that the contact group was excluded from the
© 2016 Nature America, Inc. All rights reserved.

comparison of broadband neutral faces versus neutral scenes as a result of a signal artifact in experiment 2. (b) Averaged 0
iERPs to BSF neutral faces (solid line) and neutral complex scenes (dashed line) from six fusiform contact groups (four
–40
patients, total of 11 contacts). Responses to faces were significantly greater than those to scenes between 164–176 ms
(cluster threshold P < 0.01) on cluster-based non-parametric permutation statistic, based on two-sample t test. Horizontal –80
bars indicate time clusters expressing significant effects, as described in Figure 2. Shaded area indicates s.e.m. 72–108 ms
(c–f) Fusiform gyrus iERPs from five patients and seven contact groups (total of 13 contacts) to fearful, happy and neutral
faces, collapsed across frequencies (experiment 1; c). No significant main effect of emotion was observed on cluster-based non-parametric
permutation statistic, based on MANOVA F values (Supplementary Table 8). There was a main effect of spatial frequency from 206–240 ms
(cluster threshold P < 0.01) and an emotion by spatial frequency interaction from 290–334 ms (cluster threshold P < 0.05). (d) Fusiform iERPs
to BSF, HSF and LSF faces, collapsed across emotion. (e) Fusiform gyrus iERPs to only fearful and neutral faces, collapsed across spatial frequencies.
A main effect of emotion was significant from 172–218 ms, as well as a main effect of frequency from 170–186 ms (both at cluster threshold
P < 0.05). Significant main effects of frequency between 200 and 300 ms, as well as an emotion (fear, neutral) by spatial frequency (BSF, HSF and
LSF) interaction around 300 ms, were also observed (Supplementary Table 8). (f) Fusiform iERPs to BSF, HSF and LSF fearful faces only. (g) Dot plot
of responses observed in each of the seven fusiform contact sites to fearful faces, collapsed over BSF and LSF, during the early interaction time window
derived from the amygdala iERP statistical analysis (Supplementary Table 11). Colored markers are depicted as in a. Dot plots are superimposed on the
mean (±s.e.m.) activity across all fusiform contact sites.

deflection from 104–124 ms (104 ms: t6 = 3.68, P = 0.010 uncor- right, four left, two bilateral; Table 1, Fig. 5a,b and Supplementary
rected) and a negative deflection from 178–204 (178 ms: t6 = −2.57, Table 12). Six of these nine patients also completed experiments 1.
P = 0.042 uncorrected). Thus, even applying liberal statistical criteria, Notably, we found that the earliest latency at which iERPs evoked
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the earliest deflection in fusiform cortex to BSF and LSF fearful faces by unpleasant and neutral pictures differed significantly was from
(104 ms) occurred more than 30 ms after the onset of SF-dependent ~190 ms post-stimulus onset. Cluster-based permutations compar-
amygdala responses to fearful faces observed following cluster-based ing emotional and neutral pictures revealed two significant clusters
correction. Lastly, to control for the fact that the polarity of evoked (Fig. 5c and Supplementary Table 13), which, on relaxing the cluster
potentials is unpredictable and can vary across individual contact threshold to P < 0.05, collapsed into one cluster spanning 192–280 ms
sites, we tested absolute values of each post-stimulus time point of (Fig. 5c and Supplementary Table 13). To calculate latencies at
fusiform responses against zero in a one-tailed t test, again at uncor- which iERPs to each picture type differed significantly from zero,
rected alpha of 0.05. The first significant effect for LSF fearful faces is we employed the same procedure as in experiment 1. With a cluster
again at 104 ms and for BSF fearful faces is at 108 ms. We also plotted threshold of P < 0.01, we observed significant differences from zero
the average response amplitude to fearful faces, collapsed over BSF baseline from 186 ms and 226 ms for unpleasant and neutral pictures,
and LSF, of all seven fusiform contact sites during the early amygdala respectively (Fig. 5d and Supplementary Table 14), which, on relax-
interaction time window (Fig. 4g and Supplementary Table 11), ing the cluster threshold to P < 0.05, began at 162 ms and 202 ms.
which show minimal deviations from zero. The absence of fast Thus, no differential response to emotional versus neutral scenes
responses in ventral stream also safeguards against the possibility that was observed in the early time window in which fast responses to BSF
short-latency effects in the amygdala are a result of activity derived and LSF fearful faces occurred in experiment 1. To formally test for a
from the common reference electrodes. difference between fast amygdala responses to fearful faces and emo-
tional scenes, we compared mean amplitudes of iERPs from experi-
Emotional scenes do not evoke fast amygdala responses ment 1 versus 2 in the time cluster exhibiting an early facial emotion
In experiment 2, amygdala iERPs were recorded during presentation of by frequency interaction (76–110 ms; Supplementary Table 15). That
neutral and unpleasant complex pictures, such as household scenes and is, we tested for a difference between early responses to fearful relative
mutilated bodies, respectively. The task was completed by 13 patients to neutral faces versus the response in the same early time window for
with amygdala electrodes, of whom 9 satisfied inclusion criteria (three emotional relative to neutral scenes (for these analyses we collapsed

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a r t ic l e s

Figure 5  Fast-latency amygdala a L R b L R


responses are not evoked by complex Patient 02 (L) Anterior
Patient 04 (L)
emotional pictures. (a,b) Schematic
Patient 05 (L)
summary of electrode contact localizations Patient 06 (B)
in left and right amygdala for all patients Patient 08 (R)
included in experiment 2, as described Patient 13 (R)
Patient 15 (L) Posterior
in Figure 2. (c) Human amygdala iERPs y = –2 Patient 16 (B)
from nine patients (11 amygdalae with Patient 25 (L) Lateral Medial Medial Lateral
a total of 32 contacts) to unpleasant
pictures (experiment 2) were significantly
c Unpleasant
60 Neutral
different from those evoked by neutral y = –4

Amplitude (µV)
pictures only from 192 ms to 280 ms 40
(at cluster threshold P < 0.05), encompassing
two smaller clusters from 224 ms to 252 ms 20
y = –6
and from 258 ms to 278 ms, resulting from
a cluster threshold P < 0.01, on cluster-based 0
non-parametric permutation statistic, based Time (ms)
on paired-sample t test (Supplementary y = –8 –20
–100 0 100 200 300 400 500 600
Table 13). Shaded area indicates s.e.m.
(d) Horizontal bars depict time windows in d 0 100 200 300 400 500 600
Unpleasant
which responses to unpleasant (top) and Neutral
y = –10
neutral (bottom) pictures were significantly
different from zero, on cluster-based non-parametric permutation statistic, based on one-sample t test (Supplementary Table 14). Different cluster
thresholds (P < 0.05 and P < 0.01) are coded as in Figure 2.
© 2016 Nature America, Inc. All rights reserved.

BSF and LSF face trials). In a first analysis, we entered normalized tasks requiring attention to facial emotional expression12,32, but not
mean amplitudes from all amygdalae in both experiments (10 from when patients attended to gender12, as we required in our task.
experiment 1 and 11 experiment 2) into a repeated-measures ANOVA Evidence for a fast, magnocellular pathway in processing faces in non-
with within-subject factor emotion (negative, neutral) and between- human primates is provided by monkey pulvinar recordings showing
subject factor experiment (experiments 1 and 2). This revealed a sig- 50-ms latency responses to face-like stimuli, including cartoon faces33.
nificant emotion by experiment interaction (F1,19 = 23.54, P = 0.001). By contrast, relatively few intracranial recording studies in non-human
Next, we restricted our sample to the six patients (eight amygdalae) primates have compared amygdala responses to static images of threat-
completing both tasks, and performed an ANOVA with within- related faces to non-threatening expressions. One study34 reported
subject factors emotion and task, which revealed a significant emotion increased neuronal firing to threatening faces at 120–250 ms post-
by task interaction (F1,7 = 16.96, P = 0.004). stimulus presentation, which shows homology with the main effect
of emotion that we observed in two time clusters between 118–204
DISCUSSION ms. We could not, however, evaluate fast-latency responses to threat
The existence of a subcortical route to the amygdala for rapid process- because the first 100 ms after stimulus-image onset were excluded from
ing of ecologically important stimuli has markedly influenced basic analyses34. Similarly, in a study reporting human single-unit amygdala
and clinical research on emotional processing in the brain. However, recordings32, emotion-selective units were selected in a time window
one important limitation of this low-road model1 has been an absence 250–1,750 ms post-stimulus-onset, rendering analyses agnostic to
of support from direct electrophysiological recordings in primates. An fearful face responses at fast latencies (before 250 ms).
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alternative account suggests that rapid visual processing of emotional The few prior studies reporting field potentials12,14 or oscillatory
stimuli can be mediated by other visual pathways involving visual responses11,35 from human amygdala depth recordings failed to find
cortex15. Our results provide direct empirical support for the low-road the fast-latency amygdala response that we observed. Although two
model, as we found that human amygdala intracranial responses to previous studies35,36 also presented fearful faces, they found responses
fearful, but not neutral or happy, faces at very fast latency (~70 ms) at ~130 ms (approximating the latency of the main effect of emotion
were SF dependent. This effect was localized to lateral amygdala, that we observed in the amygdala) and used only standard broadband
where sensory inputs from thalamo-amygdala and cortico-amygdala photographs. In another study reporting late (200 ms) iERPs to
pathways converge1. We found that this selective amygdala response fearful faces12, a limited number of identities (eight) were each pre-
preceded any evoked activity in face-sensitive ventral visual cortex to sented 30 times in each of two tasks. Human electrocorticographic
the same stimuli by more than 30 ms, and preceded the onset of a dif- (ECoG) recordings demonstrate item-specific repetition suppres-
ferential response to fearful faces in ventral visual cortex by ~100 ms. sion of electrophysiological responses37; thus, multiple repetitions
Our findings are therefore consistent with a bottom-up amygdala of the same stimuli may have resulted in habituation of an amygdala
response originating via a more direct subcortical magnocellular route fast response in this previous study12. To eschew this possibility, we
rather than top-down influences from higher level visual processing presented patients with 135 identity-unique facial expressions, and
stages. In contrast, the later latency main effect of emotion in the did not observe habituation following a single repetition. A further
amygdala (beginning from ~120 ms) was more consistent with emo- factor likely to have improved our ability to detect fast amygdala
tional information that arrives at the amygdala having been processed responses is that, in seven of eight patients included in experiment 1,
in visual cortex. In support of this interpretation, this later response pathology was outside of the medial temporal lobe entered into our
was evoked by HSF fearful faces (Fig. 2f,g), which also modulated analyses (Table 1), consistent with preserved amygdala function.
fusiform cortex activity (Fig. 4f), indicating engagement of slower Lastly, given that we localized fast responses to lateral amygdala, stud-
parvocellular pathways along visual cortical areas30,31. Note that more ies with recording sites more medial than those described here32 may
pronounced later latency (>200 ms) effects have been reported with be unable to detect fast-latency responses.

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a r t ic l e s

The failure of previous human intracranial studies to find a rapid in fusiform cortex. Thus, our data provide support for a low-road
amygdala response to complex emotional pictures11,14 may reflect a circuit for fear detection in the human amygdala. This pathway, and its
fundamentally faster processing time for fearful faces, which have functional properties, may also constitute an important neural substrate
important motivational and communicative value among primates38, for models of non-conscious processing in anxiety disorders42,48,49
relative to emotional scenes with multiple objects. Using complex and the generalization of fear responses to coarsely defined cues in
emotional scenes, we also found that only late-latency human pathological conditions39,50.
amygdala iERP amplitudes were modulated by emotion. The fact
that fast responses were limited to fearful faces provides support Methods
for evolutionary theories of amygdala automaticity to social threat Methods and any associated references are available in the online
signals39,40. From an evolutionary perspective, stimuli associated version of the paper.
with recurrent survival threats, such as fearful faces, require mini-
Note: Any Supplementary Information and Source Data files are available in the
mal neural processing for identification, a notion referred to as
online version of the paper.
‘preparedness’22. Moreover, the emergence of social communities and
social signals of emotions during evolution presumably contributed to Acknowledgments
making amygdala-centered circuits particularly responsive to threat We thank the electroencephalography technicians at the Hospital Ruber
Internacional. This work was supported by Project grant SAF2011-27766
cues communicated by other conspecifics, including facial expres-
from the Spanish Ministry of Science and Education and Marie Curie Career
sions40,41. Although the fast-latency response that we observed is Integration Fellowship (FP7-PEOPLE-2011-CIG 304248) to B.A.S., a PICATA
selective for fearful versus happy and neutral faces, fast responses fellowship of CEI Moncloa (UCM-UPM) to C.M.-B., and a Ramón y Cajal
may also occur to other negative facial expressions such as anger. fellowship (RYC-2009-04974) to S.M. This work was supported by Project grant
It remains to be tested whether fast human amygdala responses occur SAF2011-27766 from the Spanish Ministry of Science and Education, Marie Curie
Career Integration Fellowship (FP7-PEOPLE-2011-CIG 304248), and BIAL
to simple, biologically relevant stimuli, such as snakes, that provided Foundation Grant 119/12 to B.A.S.
© 2016 Nature America, Inc. All rights reserved.

survival threat during evolution22,42.


Accounts of automaticity in fear processing also suggest that amy- AUTHORS CONTRIBUTIONS
gdala responses to emotional stimuli occur regardless of attentional C.M.-B., S.M., P.V., A.G.-N. and B.A.S. designed the experiments. C.M.-B., F.L.-S.
and R.T. collected data and C.M.-B., S.M. and B.A.S. performed analyses. R.T. and
resources available or competition between concurrent inputs16,39,43,
A.G.-N. monitored patients and performed clinical evaluation. R.M.-A. performed
and are not necessarily under voluntary control44. We did not explicitly surgical electrode implantation. Y.H.M. designed and performed electrode contact
manipulate attention in either experiments 1 or 2; amygdala responses localization. B.A.S., C.M.-B., S.M. and P.V. wrote the paper with input from all of
were observed during incidental tasks of gender or indoor/outdoor the other authors.
judgments, respectively. Nonetheless, we note that automatic amygdala
COMPETING FINANCIAL INTERESTS
responses independent of attention would be predicted by the exist- The authors declare no competing financial interests.
ence of fast, subcortical inputs16,39, for which our data provide, to the
best of our knowledge, the first direct electrophysiological support Reprints and permissions information is available online at http://www.nature.com/
in humans. However, it remains possible that amygdala responses to reprints/index.html.
coarse inputs without attention may involve other cortical or subcorti-
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ONLINE METHODS significant differences in the pixel value distributions between emotions within
Participants. Participants were medication-resistant epilepsy patients with each spatial frequency (Anderson-Darling k-sample tests: for BSF AD = 1.06,
depth electrodes surgically implanted to aid seizure focus localization (Table 1). tAD = −0.88, asymptotic P = 0.843; for HSF AD = 0.06, tAD = −1.81, asymptotic
Implantation sites were chosen solely on the basis of clinical criteria. Patients P = 1; for LSF AD = 1.10, tAD = −0.84, asymptotic P = 0.824). For each patient, 135
had normal or corrected-to-normal vision and had no history of head trauma different identities (out of the 139 that composed the whole set) were randomly
or encephalitis. Their amygdalae were radiologically normal on pre-operative selected for presentation. Each of the 135 identities was pseudorandomly assigned
MRI (Supplementary Fig. 1). No statistical methods were used to pre-determine to one of the nine possible conditions: BSF fearful, HSF fearful, LSF fearful, BSF
sample sizes but our sample sizes are larger to those reported in previous publica- happy, HSF happy, LSF happy, BSF neutral, HSF neutral and LSF neutral faces.
tions11–14,35. All patients signed informed consent. The study had full approval Thus, each condition was composed of 15 different identities, unique to that con-
from the Hospital Ruber Internacional Ethics Committee. dition. Pseudo-randomization proceeded such that either eight or seven identities
shared gender in each condition. Once the 135 faces were selected, their order of
Stereotactic electrode implantation. A contrast enhanced MRI was performed presentation was randomized. The task was repeated twice. In the second block,
pre-operatively under stereotactic conditions to map vascular structures prior to performed 10 min after the first, the same stimuli were presented as the first
electrode implantation and to calculate stereotactic coordinates for trajectories block, but in a different pseudo-random order.
using the Neuroplan system (Integra Radionics). DIXI Medical Microdeep depth Procedure. Experiments were conducted during the second post-operative day.
electrodes (multicontact, semi rigid, diameter of 0.8 mm, contact length of 2 mm, All patients were seizure free for the previous 12h. In each of 2 experimental
inter-contact isolator length of 1.5 mm) were implanted based on the stereotactic blocks, faces were centrally displayed on an LCD computer screen for 500 ms
Leksell method. followed by a fixation cross for 3500 ms. Patients were required to make a gender
judgment, via button press, for each face (this task was employed because gender
Electrode contact localization. To take advantage of the visibility of individual judgments rely equally on HSF and LSF information, with no dominance by either
electrode contacts on CT images, for each patient we co-registered the pre- spatial frequency range56). Patients remained as still as possible attending the
electrode placement T1-weighted magnetic resonance images (pre-MRI) to centre of the screen while avoiding verbalizations and minimizing eye-blinks.
post-electrode placement CT (post-CT) whole-brain volumes. MRIs were Data acquisition. Ongoing intracranial electroencephalogram (iEEG) activity
© 2016 Nature America, Inc. All rights reserved.

acquired on a 3 T Signa HDx GE scanner (GE Healthcare). To optimize this co- was acquired using an XLTEK EMU128FS amplifier (XLTEK). iEEG data were
registration, both brain images were first skull-stripped. For CTs this was done recorded at each electrode contact site at a 500-Hz sampling rate (online bandpass
by filtering out all voxels with signal intensities between 100 and 1,300 HU. Skull filter 0.1–150 Hz) and referenced to linked mastoid electrodes. The accuracy
stripping of the pre-MRI proceeded by first spatially normalizing the image to of stimulus onset latencies was first measured with a photo-diode and a light-
MNI space employing the New Segment algorithm in SPM8 The resultant inverse to-voltage converter (TKK Brain Research Unit), and latency uncertainty found
normalization parameters were then applied to the brain mask supplied in SPM8 to be in the range of 2 ms.
to transform the brain mask into the native space of the pre-MRI. All voxels in
pre-MRI lying outside the brain mask and possessing a signal value in the high- Data analysis. Patient inclusion. Of 16 patients with amygdala electrodes who
est 15th percentile were filtered out. The skull-stripped pre-MRI was then co- completed the task, four patients did not meet our criteria for spike-free trials
registered and re-sliced to the skull-stripped post-CT. Next, the pre-MRI was (75%) and were thus excluded. A further two patients were excluded due to poor
affine normalized to the post-CT, thus transforming the pre-MRI image into task engagement (12% and 38% trials in which responses were omitted, respec-
native post-CT space. The two images were then overlaid, with the post-CT tively, compared to an average 0.67% across all other patients). One patient was
thresholded such that only electrode contacts were visible. excluded due to the presence of large-amplitude slow oscillations during record-
ing. Lastly, electrophysiological responses from one patient did not demonstrate
Electrode contact visualization. To construct schematic summary illustra- any discernible stimulus-evoked components during the 640-ms post-onset inter-
tions of the localizations of all amygdala contacts entered into our analyses, the val. Data from this patient were also excluded. Thus, we analyzed iERPs from ten
coordinates—in native post-CT space—were identified for the center of each amygdalae from eight patients (four left-sided, two right-sided and two bilater-
contact in each amygdala. For each patient, the pre-MRI (now in native post-CT ally implanted). Patient demographics and clinical details are given in Table 1.
space) was then spatially normalized to MNI space, the ensuing normalization Although patient 5 had procedural and verbal IQ in the borderline and extremely
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parameters applied to each of the amygdala contact coordinates for that patient, low range, respectively (Table 1), this patient’s gender judgment performance was
and the resultant MNI coordinates indicated on the MNI template brain comparable to that of other patients (Supplementary Table 1).
(Figs. 2a and 5a). This approach was adopted instead of spatially normalizing Pre-processing. For each amygdala contact, experimental condition, and
the fused pre-MRI and post-CT image to MNI space, because the latter approach patient, epochs from −200 to 640-ms peri-stimulus time were extracted from
distorts contact topography. To provide a three-dimensional view of contact continuous iEEG data. Epochs containing epileptiform activity or artifacts
localizations, the cytoarchitectonically defined amygdala51, provided in the (large-amplitude slow-wave drifts or high-frequency activity) were rejected
SPM Anatomy toolbox, was obtained by thresholding the separate laterobasal, by trial-by-trial visual inspection, as were epochs corresponding to absent or
centromedial, and superficial group probability maps at ≥ 0.3, and combining multiple behavioral responses. Epochs were then detrended, baseline corrected
them into a single amygdala volume. The surface contour of the amygdala volume (100-ms pre-stimulus baseline) and no filter was applied. No further off-line fil-
(in standard MNI space) was then rendered in Paraview52 (Figs. 2b and 5b). tering of the data was performed to avoid filter effects that may distort waveforms
and hence introduce latency artifacts57. For each experimental condition, data
Experiment 1: emotional faces. Stimuli. We compiled faces of 139 different were then averaged across the two blocks. In the case that there was more than
actors (69 female) posing fearful, happy, and neutral expressions from three one contact within the amygdala, data from all contacts were averaged within
databases: Karolinska Directed Emotional Faces (http://www.emotionlab. trial for that amygdala.
se/resources/kdef)53, Warsaw Set of Emotional Facial Expression Pictures (http:// Statistics. We applied a cluster-based non-parametric permutation statistic,
www.emotional-face.org/)54 and Radboud Faces Database (http://www.socsci. based on MANOVA F values with within-subject factors of emotion (fear, happy,
ru.nl:8180/RaFD2/RaFD)55. Eye gaze of all face stimuli was directed forward. neutral) and spatial frequency (BSF, LSF, HSF), to determine the time points of
Images were gray-scaled and enclosed in a rectangular frame (198 × 251 pixels) significant interaction between emotion and spatial frequency with respect to
excluding most hair and background (Fig. 1). Spatial frequency content in the iERP amplitude. This approach effectively corrects the family-wise error rate in
original stimuli (BSF) was filtered using a high-pass cut-off of >24 cycles per the context of multiple comparisons of latency bins23. Under the null hypothesis
image for HSF stimuli, and a low-pass cut-off of <6 cycles per image for LSF of no differences between levels of each test (main effects of emotion or spatial
stimuli (using Matlab, The Mathworks). Presented faces subtended a visual angle frequency, and their interaction), the amplitude values at each time point can
of 7.4°, resulting in spatial frequency cut-offs of 3.24 and 0.81 cycles per degree for be permuted between conditions within each factor. After a permutation step,
HSF and LSF, respectively. Lastly, brightness was equalized across all nine condi- a MANOVA was calculated at each time point for each test separately, with a
tions (mean gray scale pixel values 115). Further, we ensured that there were no cluster threshold of P < 0.01 for the main effects and interaction. Thus, significant

nature NEUROSCIENCE doi:10.1038/nn.4324


time clusters were formed by temporal adjacency of supra-threshold effects number of subjects showing at least 50% of the maximum activation at that dipole
(a cluster contained at least two significant neighbors along the time dimension). was counted. This process was then repeated for the later main effect of emotion
For each cluster, the MANOVA F values (Wilk’s lambda) of the corresponding time window (282–302 ms). Note that for patient 10, source localization was not
test were summed and the greatest sum among all clusters entered into the per- possible due to two channels within, and five channels lateral to, the amygdala
mutation distribution. Note that as the permutation distribution is a data-driven (seven of ten channels) displaying a flat signal, prohibiting the calculation of a
non-parametric distribution, no degrees of freedom are given. Permutation steps potential gradient along the electrode contacts.
were repeated 1,000 times and permutation distributions for main effects and Eye movements. Although eye movements were not recorded in the current
interactions created. Initially, empirical cluster sums of MANOVA F values that experiment, it is unlikely that task-related saccadic eye movements can account
were greater than the 99th centile within the permutation distribution were con- for the fast amygdala responses we observe. A previous fMRI study comparing
sidered as significant temporal clusters of emotion/spatial frequency main effects responses to fearful versus neutral BSF, HSF and LSF faces reported no signifi-
or interaction. We next applied a less conservative cluster threshold of P < 0.05 cant effects or interaction due to SF or emotion in mean eye-position data over
and repeated the permutation testing. The more conservative (P < 0.01) and a 200-ms period after stimulus onset19. Furthermore, iERP recordings are
relaxed (P < 0.05) cluster thresholds were applied in order to balance risk of false considered relatively less susceptible to eye movement artifacts compared to
positives (that is, that weak, neighboring single-time-point effects combine into scalp-recorded ERPs62.
a significant cluster) and risk of false negatives, respectively. A MANOVA was
chosen over univariate ANOVA to eschew violation of the sphericity assump- Experiment 2: emotional pictures. Experiment 2 proceeded in an identical man-
tion. Next, to explore the differences in each significant time cluster (for main ner to experiment 1, except for the following:
effects and interaction), the mean amplitude values for each subject and each Stimuli. Patients were presented with 40 emotional and 80 neutral color
condition across the significant clusters were computed for each effect and tested pictures. These were drawn at random from a pool of 80 high-arousing unpleasant
with specific contrasts and post hoc t tests. When applying parametric tests, data (mutilations and attack) scenes selected from the International Affective Picture
distribution was assumed to be normal, but this was not formally tested. Finally, System63 (IAPS), and 160 low-arousing neutral pictures: 149 taken from the IAPS
we applied cluster-based permutation statistics on the iERP to each of the nine (household scenes and neutral persons) and eleven neutral landscape pictures
face stimulus types separately, to test a null hypothesis of deflections being equal taken from the world-wide web. Mean normative IAPS picture ratings (SEM)
© 2016 Nature America, Inc. All rights reserved.

to zero for the entire post-stimulus period. on a nine-point scale for valence were 5.05 (0.05) for neutral, and 2.04 (0.05) for
Of 14 patients with amygdala electrodes who met inclusion criteria on the basis unpleasant pictures, and for arousal were 3.29 (0.06), and 6.3 (0.07) for neutral
of performance on the gender judgment task, seven also had electrodes in visual and unpleasant pictures, respectively. Note that in both experiments 1 and 2, the
areas. Identical data pre-processing steps were employed for these iEEG data as ratio of negative emotional to non-negative stimuli was 1:2.
for amygdala contacts, with one patient rejected for not meeting criterion for Procedure. This experiment was conducted during the third post-operative day.
spike-free trial number. A further patient did not have contacts in the fusiform Emotional and neutral pictures were presented pseudo-randomly (presentation
gyrus. Thus, from five patients, seven groups of fusiform contacts were entered time 500 ms; interstimulus interval 3,500 ms) with a constraint that emotional
into the same cluster-based permutations statistics as applied to amygdala contact pictures were separated by at least one neutral picture. Patients were required
data (again with cluster threshold of P < 0.01 followed by P < 0.05). To test for to make an indoor-outdoor judgment to each via button-press. Prior to signing
latency effects of BSF and LSF fearful faces employing non-corrected statistics, we informed consent, patients were shown one example of an unpleasant IAPS
compared iERPs for each stimulus type relative to zero in two-tailed one-sample picture and instructed that they would see similar pictures both on that day and
t tests. Only time clusters with more than four adjacent data points (that is, at the next (patients saw the same pictures again the next day during a recognition
least 10 ms) are considered significant. memory test).
For those patients for whom responses were successfully recorded simul-
taneously from both amygdala and fusiform (four patients), we computed Data acquisition. This was identical to experiment 1, but on post-operative day 3.
the average values for fearful, happy, and neutral faces across all frequencies.
To test the interaction between electrode site (amygdala, fusiform) and emotion Data analysis. Patient inclusion. Of 14 patients who completed the task, nine
(fearful, happy and neutral) we calculated difference values with respect to the met all inclusion criteria. Two patients were excluded due to poor push-but-
three different combinations of the factor levels for emotion at each electrode site. ton response rate (36% and 28% trials in which responses were omitted com-
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For each emotion, the amplitude differences between electrode sites were also pared to 1.22% mean omissions for the nine patients included in the analysis).
determined. The difference values were submitted to non-parametric Friedman A further three patients did not meet our criteria for spike-free trials (75%).
tests. Significant interactions between electrode sites and emotion were further Patient demographics and clinical details are given in Table 1. Despite bor-
analyzed by Wilcoxon signed ranked tests applied to the factors emotion and derline and extremely low range IQs of patients 5 and 8, these patients’ reac-
electrode site. Data collection and analysis were not performed blind to the con- tion times on the indoor/outdoor task were comparable to other patients’
ditions of experiments 1 or 2. A Supplementary Methods Checklist is available (Supplementary Table 12).
and includes statistics derived from experiments 1 and 2. Preprocessing. After spike and artifact rejection, data preprocessing was as for
Source localization of amygdala responses. Electrodes containing amygdala experiment 1; epochs of unfiltered data were detrended and baseline corrected
contacts were selected for each patient, and the average responses to BSF and (100-ms pre-stimulus baseline).
LSF fearful faces from all contacts of each selected electrode (that is, within Statistics. For statistical comparison of evoked responses, we applied the same
and outside the amygdala) were analyzed. Noisy channels were removed. Thus cluster-based permutation approach as for experiment 1, but a paired t test was
data from 5–12 contacts per electrode were submitted to source localization at used as the initial cluster statistic to compare emotional versus neutral pictures.
the individual patient level, implemented in Brainstorm58 software. After co- To calculate the points in time at which iERPs started to differ significantly from
registration of the individual pre-operative MRIs with post-operative CT scans, zero, we used the same procedure as for experiment 1 iERPs.
a dipole grid (20,000 dipoles) restricted to the neocortex, amygdala and hip- For the four patients with electrodes in the fusiform gyrus who completed
pocampus was used as a brain model to estimate the current source distribution. both experiments 1 and 2, evoked responses to BSF neutral faces recorded in
This dipole grid was used to calculate a forward model employing the bound- experiment 1 were compared to those evoked by neutral scenes in experiment 2,
ary element method59. An l2-weighted minimum norm algorithm (wMNE)60 again employing cluster-based permutations statistics with a cluster threshold of
was then applied to obtain mean current source densities for the time windows P < 0.01 (n = 6 groups of contacts). Note that some neutral IAPS pictures (18%)
corresponding to the observed early (76–110 ms) response to fear. To measure contained human faces embedded within the scenes, which were removed from
the consistency of this localization over all amygdalae, each wMNE solution this analysis.
was normalized to MNI space61 using SPM8. The wMNE solutions for right-
sided amygdalae electrodes were flipped on the left-right axis. Lastly, for each of Data availability. The data that support the findings of this study are available
the 20,000 dipoles comprising the neocortex, amygdala and hippocampus, the from the corresponding author upon request.

doi:10.1038/nn.4324 nature NEUROSCIENCE


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