Non-ictal, interictal and ictal déjà vu: a systematic review and meta-analysis.

Background: Déjà vu, French for "already seen," is a phenomenon most people will experience at least once in their lifetime. Emerging evidence suggests that déjà vu occurs in healthy individuals (as "non-ictal déjà vu") and in epilepsy patients during seizures (as "ictal déjà vu") and between seizures (as "interictal déjà vu"). Although the ILAE has recognized déjà vu as a feature of epileptic seizures, it is notably absent from the ICD-11. A lack of evidence-based research may account for this omission. To our knowledge, this study represents the first systematic review and meta-analysis on déjà vu experiences. Through detailed examinations of non-ictal, interictal and ictal déjà vu, we seek to highlight possible clinical implications. Rethinking the status quo of ictal déjà vu could potentially lead to earlier interventions and improve outcomes for epilepsy patients. Methods: This study was registered in PROSPERO (ID: CRD42023394239) on 5 February 2023. Systematic searches were conducted across four databases: EMBASE, MEDLINE, PsycINFO, and PubMed, from inception to 1 February 2023, limited to English language and human participants. Studies were included/excluded based on predefined criteria. Data was extracted according to the PICO framework and synthesized through a thematic approach. Meta-analyses were performed to estimate prevalence's of the phenomena. Study quality, heterogeneity, and publication bias were assessed. Results: Database searching identified 1,677 records, of which 46 studies were included. Meta-analyses of prevalence showed that non-ictal déjà vu was experienced by 0.74 (95% CI [0.67, 0.79], p < 0.001) of healthy individuals, whereas interictal déjà vu was experienced by 0.62 (95% CI [0.48, 0.75], p = 0.099) and ictal déjà vu by 0.22 (95% CI [0.15, 0.32], p = 0.001) of epilepsy patients. Examinations of phenomenological (sex, age, frequency, duration, emotional valence, and dissociative symptoms) and neuroscientific (brain structures and functions) data revealed significant variations between non-ictal, interictal and ictal déjà vu on several domains. Conclusion: This systematic review and meta-analysis do not support the notion that non-ictal, interictal and ictal déjà vu are homogenous experiences. Instead, it provides insight into ictal déjà vu as a symptom of epilepsy that should be considered included in future revisions of the ICD-11. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394239, CRD42023394239.

Déjà vu in idiopathic generalized epilepsy: A systematic review.

INTRODUCTION: Déjà vu (DV), a French term meaning "already seen," refers to inappropriate sensation of familiarity in the present moment, as if it had been experienced before without a specific recollection of when or where. Traditionally, DV has been closely associated with focal seizures originating from the medial temporal lobe. However, there are occasional reports of DV occurring in idiopathic generalized epilepsies (IGEs). The objective of our study was to assess the presence and frequency of DV in individuals with IGE. METHODS: We used the Preferred Reporting Items for Systematic Review and Meta-Analysis for protocols (PRISMA-P) and searched PubMed and Embase from January 2000 to July 2022. RESULTS: 5 studies were included with a total of 1177 IGE and 1026 with temporal lobe epilepsy (TLE) patients. The frequency of DV in IGE ranged from 0 to 11 %, and the average was 3 %, compared to 19.6 % in TLE. Broadly, 40 % of patients with IGE reported some type of aura. EEG correlation of DV in IGE was not appropriately evaluated in the studies. CONCLUSION: Clinicians should be aware that individuals with IGE may experience DV and other types of auras. Recognizing these auras is crucial in order to avoid misdiagnosing IGE as focal epilepsy. This is important to prevent unnecessary investigations and incorrect treatment decisions.

Towards a conflict account of déjà vu: The role of memory errors and memory expectation conflict in the experience of déjà vu.

Déjà vu can be defined as conflict between a subjective evaluation of familiarity and a concurrent evaluation of novelty. Accounts of the déjà vu experience have not explicitly referred to a "conflict account of déjà vu" despite the acceptance of conflict-based definitions of déjà vu and relatively recent neuroimaging work that has implicated brain areas associated with conflict as underpinning the experience. Conflict monitoring functioning follows a similar age-related trajectory to déjà vu with a peak in young adulthood and a subsequent age-related decline. In this narrative review of the literature to date, we consider how déjà vu is defined and how this has influenced the understanding of déjà vu. We also review how déjà vu can be understood within theories of recognition memory and cognitive control. Finally, we summarise the conflict account of déjà vu and propose that this account of the experience may provide a coherent explanation as to why déjà vu experiences tend to decrease with age in the non-clinical population.

A virtual reality paradigm with dynamic scene stimuli for use in memory research.

Episodic memory may essentially be memory for one's place within a temporally unfolding scene from a first-person perspective. Given this, pervasively used static stimuli may only capture one small part of episodic memory. A promising approach for advancing the study of episodic memory is immersing participants within varying scenes from a first-person perspective. We present a pool of distinct scene stimuli for use in virtual environments and a paradigm that is implementable across varying levels of immersion on multiple virtual reality (VR) platforms and adaptable to studying various aspects of scene and episodic memory. In our task, participants are placed within a series of virtual environments from a first-person perspective and guided through a virtual tour of scenes during a study phase and a test phase. In the test phase, some scenes share a spatial layout with studied scenes; others are completely novel. In three experiments with varying degrees of immersion, we measure scene recall, scene familiarity-detection during recall failure, the subjective experience of déjà vu, the ability to predict the next turn on a tour, the subjective sense of being able to predict the next turn on a tour, and the factors that influence memory search and the inclination to generate candidate recollective information. The level of first-person immersion mattered to multiple facets of episodic memory. The paradigm presents a useful means of advancing mechanistic understanding of how memory operates in realistic dynamic scene environments, including in combination with cognitive neuroscience methods such as functional magnetic resonance imaging and electrophysiology.

Piquing Curiosity: Déjà vu-Like States Are Associated with Feelings of Curiosity and Information-Seeking Behaviors.

Curiosity during learning increases information-seeking behaviors and subsequent memory retrieval success, yet the mechanisms that drive curiosity and its accompanying information-seeking behaviors remain elusive. Hints throughout the literature suggest that curiosity may result from a metacognitive signal-possibly of closeness to a not yet accessible piece of information-that in turn leads the experiencer to seek out additional information that will resolve a perceptibly small knowledge gap. We examined whether metacognition sensations thought to signal the likely presence of an as yet unretrieved relevant memory (such as familiarity or déjà vu) might be involved. Across two experiments, when cued recall failed, participants gave higher curiosity ratings during reported déjà vu (Experiment 1) or déjà entendu (Experiment 2), and these states were associated with increased expenditure of limited experimental resources to discover the answer. Participants also spent more time attempting to retrieve information and generated more incorrect information when experiencing these déjà vu-like states than when not. We propose that metacognition signaling of the possible presence of an as yet unretrieved but relevant memory may drive curiosity and prompt information-seeking that includes further search efforts.

What Flips Attention?

A central feature of our waking mental experience is that our attention naturally toggles back and forth between "external" and "internal" stimuli. In the midst of an externally demanding task, attention can involuntarily shift internally with no clear reason how or why thoughts momentarily shifted inward. In the case of external attention, we are typically exploring and encoding aspects of our external world, whereas internal attention often involves searching for and retrieving potentially relevant information from our memory networks. Cognitive science has traditionally focused on understanding forms of internal and external attention separately, leaving a mystery about what sparks the seemingly automatic shifts between the two. Specifically, what shifts attentional focus from being outward-directed to being inward-directed? We present a candidate mechanism: Familiarity-detection.

An Unusual Presentation of Stroke and Reperfusion: A Case Report.

Intravenous tissue plasminogen activator (tPA) is a mainstay of therapy in acute ischemic stroke but transient neurologic changes related to reperfusion have not been well described. One of the authors (ISN) experienced a cardioembolic stroke due to apical hypertrophic cardiomyopathy with a left ventricular apical aneurysm. He received tPA and we describe his unusual cognitive symptoms during the infusion. The patient's presenting neurologic deficit improved with tPA, suggesting reperfusion. His subsequent restlessness, disorientation, and déjà vu lasted about 10 minutes and resolved spontaneously. Imaging studies confirmed an ischemic infarction in the left posterior cerebral artery (PCA) distribution. Cardiac events, including arrhythmias related to coronary reperfusion after myocardial infarction, are well described. Neurologic events due to reperfusion have not been previously described in patients with stroke. We describe a case of transient neurologic symptoms during revascularization of an embolic stroke.

The phenomenology of autobiographical retrieval.

In this article we review the literature on the phenomenology of retrieval from the personal past, and propose a framework for understanding how epistemic feelings and metacognitive reflections guide the retrieval of representations of past events in the Self Memory System. Our focus is on an overlooked aspect of autobiographical memory, the phenomenology of the retrieval process, as opposed to the products of retrieval themselves. As we argue in the present paper, this is not some magical collection of phenomena, but centers on the feeling of familiarity derived from retrieval fluency during the process of retrieval. The relationship between retrieval fluency and retrieved content, interpreted metacognitively is what gives autobiographical retrieval its particular phenomenological "flavor." To illustrate our point, we focus on two phenomena that only recently were considered alongside each other: the déjà vu experience and involuntary autobiographical memories. Our proposal is that the feeling of familiarity (i.e., this reminds me of something) for the personal past acts to guide deliberate, conscious memory search. We argue that the critical concept in the phenomenology of retrieval is fluency-how readily information comes to mind. This article is categorized under: Psychology > Memory Philosophy > Consciousness Philosophy > Knowledge and Belief.

Opening a conceptual space for metamemory experience.

The experiences associated with remembering, including metamemory feelings about the act of remembering and attempts at remembering, are not often integrated into general accounts of memory. For example, David Rubin (2022) proposes a unified, three-dimensional conceptual space for mapping memory states, a map that does not systematically specify metamemory feelings. Drawing on Rubin's model, we define a distinct role for metamemory in relation to first-order memory content. We propose a fourth dimension for the model and support the proposal with conceptual, neurocognitive, and clinical lines of reasoning. We use the modified model to illustrate several cases, and show how it helps to conceptualize a new category of memory state: autonoetic knowing, exemplified by déjà vu. We also caution not to assume that memory experience is directly correlated with or caused by memory content, an assumption Tulving (1989) labeled the doctrine of concordance.

Are involuntary autobiographical memory and déjà vu natural products of memory retrieval?

Involuntary autobiographical memories (IAMs) and déjà vu are phenomena that occur spontaneously in daily life. IAMs are recollections of the personal past, whereas déjà vu is defined as an experience in which the person feels familiarity at the same time as knowing that the familiarity is false. We present and discuss the idea that both IAMs and déjà vu can be explained as natural phenomena resulting from memory processing and, importantly, are both based on the same memory retrieval processes. Briefly, we hypothesise that both can be described as "involuntary" or spontaneous cognitions, where IAMs deliver content and déjà vu delivers only the feeling of retrieval. We map out the similarities and differences between the two, making a theoretical and neuroscientific account for their integration into models of memory retrieval and how the autobiographical memory literature can explain these quirks of daily life and unusual but meaningful phenomena. We explain the emergence of the déjà vu phenomenon by relating it to well-known mechanisms of autobiographical memory retrieval, concluding that IAMs and déjà vu lie on a continuum.

Entropy, Amnesia, and Abnormal Déjà Experiences.

Previous research has contrasted fleeting erroneous experiences of familiarity with equally convincing, and often more stubborn erroneous experiences of remembering. While a subset of the former category may present as nonpathological "déjà vu," the latter, termed "déjà vécu" can categorize a delusion-like confabulatory phenomenon first described in elderly dementia patients. Leading explanations for this experience include the dual process view, in which erroneous familiarity and erroneous recollection are elicited by inappropriate activation of the parahippocampal cortex and the hippocampus, respectively, and the more popular encoding-as-retrieval explanation in which normal memory encoding processes are falsely flagged and interpreted as memory retrieval. This paper presents a novel understanding of this recollective confabulation that builds on the encoding-as-retrieval hypothesis but more adequately accounts for the co-occurrence of persistent déjà vécu with both perceptual novelty and memory impairment, the latter of which occurs not only in progressive dementia but also in transient epileptic amnesia (TEA) and psychosis. It makes use of the growing interdisciplinary understanding of the fluidity of time and posits that the functioning of memory and the perception of novelty, long known to influence the subjective experience of time, may have a more fundamental effect on the flow of time.

Déjà-vu evoked by electrical stimulation of the insula: Stimulation-induced insular déjà-vu.

OBJECTIVE: Déjà-vu is a mental phenomenon commonly experienced during temporal lobe seizures and can be evoked by electrical stimulation of the temporal lobe. We analyzed reproducible déjà-vu experiences evoked by stimulating the insula in two patients with pharmacoresistant temporal lobe epilepsy. METHODS: We reviewed video-electroencephalography (EEG) recordings from extraoperative electrical cortical stimulation sessions. In addition, we performed the directed transfer function (DTF) effective connectivity measure of monopolar signals in Patient 1. To highlight elective changes due to each stimulation, we subtracted pre-stimulation DTF matrices from early poststimulation matrices. This analysis was performed for both non-inducing-déjàvu stimulation (control matrix) and déjà-vu-inducing stimulation (active matrix). Finally, the control matrix was subtracted from the active matrix. RESULTS: Comparison of effective connectivity during control stimulation versus déjà-vu-inducing stimulation revealed a reversal of connectivity levels in three main regions: the contralateral inferior insula (the ipsilateral insula could not be analyzed), bilateral mesiotemporal regions and the ipsilateral superior frontal gyrus. The drivers of evoked déjà-vu were the mesiotemporal regions (mainly ipsilateral) and the ipsilateral superior frontal gyrus. SIGNIFICANCE: Although our findings are possibly anecdotal, the insula may (in rare instances) remotely generate unexpected déjà-vu. If confirmed by further studies, this might change the assessment strategy for possible causes of anterior temporal lobectomy failure.

Insights into déjà vu: Associations between the frequency of experience and amplitudes of low-frequency oscillations in resting-state functional magnetic resonance imaging.

The phenomenon of déjà vu (DV) has intrigued scientists for decades, yet its neurophysiological underpinnings remain elusive. Brain regions have been identified in which morphometry differs between healthy individuals according to the frequency of their DV experiences. This study built upon these findings by assessing if and how neural activity in these and other brain regions also differ with respect to DV experience. Resting-state fMRI was performed on 68 healthy volunteers, 44 of whom reported DV experiences (DV group) and 24 who did not (NDV group). Using multivariate analyses, we then assessed the (fractional) amplitude of low-frequency fluctuations (fALFF/ALFF), a metric that is believed to index brain tissue excitability, for five discrete frequency bands within sets of brain regions implicated in DV and those comprising the default mode network (DMN). Analyses revealed significantly lower values of fALFF/ALFF for specific frequency bands in the DV relative to the NDV group, particularly within mesiotemporal structures, bilateral putamina, right caudatum, bilateral superior frontal cortices, left lateral parietal cortex, dorsal and ventral medial prefrontal cortex, and the posterior cingulate cortex. The pattern of differences in fALFF/ALFF measures between the brains of individuals who have experienced DV and those who have not provides new neurophysiological insights into this phenomenon, including the potential role of the DMN. We suggest that the erroneous feeling of familiarity arises from a temporary disruption of cortico-subcortical circuitry together with the upregulation of cortical excitability.

Subjective distinguishability of seizure and non-seizure Déjà Vu: A case report, brief literature review, and research prospects.

Roughly two-thirds of all people report having experienced déjà vu-the odd feeling that a current experience is both novel and a repeat or replay of a previous, unrecalled experience. Reports of an association between déjà vu and seizure aura symptomatology have accumulated for over a century, and frequent déjà vu is also now known to be associated with focal seizures, particularly those of a medial temporal lobe (MTL) origin. A longstanding question is whether seizure-related déjà vu has the same basis and is the same subjective experience as non-seizure déjà vu. Survey research suggests that people who experience both seizure-related and non-seizure déjà vu can often subjectively distinguish between the two. We present a case of a person with a history of focal MTL seizures who reports having experienced both seizure-related and non-seizure common déjà vu, though the non-seizure type was more frequent during this person's youth than it is currently. The patient was studied with a virtual tour paradigm that has previously been shown to elicit déjà vu among non-clinical, young adult participants. The patient reported experiencing déjà vu of the common non-seizure type during the virtual tour paradigm, without associated abnormalities of the intracranial EEG. We situate this work in the context of broader ongoing projects examining the subjective correlates of seizures. The importance for memory research of virtual scenes, spatial tasks, virtual reality (VR), and this paradigm for isolating familiarity in the context of recall failure are discussed.

Déjà vu and the feeling of prediction: an association with familiarity strength.

A recent laboratory study by Cleary and Claxton [2018. Déjà vu: An illusion of prediction. Psychological Science, 29(4), 635-644. http://journals.sagepub.com/doi/full/10.1177/0956797617743018] documented a relationship between déjà vu and feelings of premonition. During instances of retrieval failure, participants reported stronger feelings of prediction during déjà vu than non-déjà vu states, despite displaying no actual predictive ability in such instances. The present study further explored the link between déjà vu reports and feelings of prediction. Although feelings of prediction were more likely to occur during reports of déjà vu than non-déjà vu, they were not the sole defining feature of déjà vu, accounting for just over half of all reported déjà vu states. Instances of déjà vu that were accompanied by feelings of prediction were associated with greater feelings of familiarity than instances that were not. This was shown by a greater likelihood of reporting that the scene felt familiar and also by a higher rated intensity of the feeling of familiarity elicited by the scene when it did feel familiar. Though the present study was mainly descriptive in characterising the interrelations between déjà vu, feelings of prediction, and familiarity, the full pattern points toward the possibility that high familiarity intensity may contribute to the feeling of prediction during déjà vu.

Déjà vu experiences in anxiety.

Déjà vu occurs when a novel event is experienced with an erroneous sense of familiarity. Memory researchers theorise that this arises due to an error in the processes underlying the recognition memory system. Research has indicated that there may be a link between high levels of anxiety and increased frequency and intensity of déjà vu, however, there has been a comparatively little characterisation of déjà vu as experienced by individuals with clinical anxiety. We used an online questionnaire to collect data from individuals self-reporting a clinical diagnosis of anxiety, as well as from age-matched controls. The Anxiety Group reported a significantly higher frequency of déjà vu episodes over the previous month than controls. They also reported experiencing déjà vu more frequently and with higher intensity during periods of high anxiety. In addition, the Anxiety Group reported finding déjà vu episodes significantly more distressing than the Control Group. The findings indicate that there are differences in déjà vu experienced by people reporting high levels of anxiety compared to healthy controls without an anxiety diagnosis. We discuss structural and neural mechanisms thought to underpin déjà vu in relation to these results.

Déjà vu and the entorhinal cortex: dissociating recollective from familiarity disruptions in a single case patient.

Past research has demonstrated a relationship between déjà vu and the entorhinal cortex in patients with wider medial temporal lobe damage. The aim of the present research was to investigate this crucial link in a patient (MR) with a selective lesion to the left lateral entorhinal cortex to provide a more direct exploration of this relationship. Two experiments investigated the experiences of déjà vécu (using the IDEA questionnaire) and déjà vu (using an adapted DRM paradigm) in MR and a set of matched controls. The results demonstrated that MR had quantitatively more and qualitatively richer recollective experiences of déjà vécu. In addition, under laboratory-based déjà vu conditions designed to elicit both false recollection (critical lures) and false familiarity (weakly-associated lures), MR only revealed greater memory impairments for the latter. The present results are therefore the first to demonstrate a direct relationship between the entorhinal cortex and the experience of both déjà vu and déjà vécu. They furthermore suggest that the entorhinal cortex is involved in both weakly-associative false memory as well as strongly-associative memory under conditions that promote familiarity-based processing.

Overcoming familiarity illusions in a single case with persistent déjà vu.

While occasional déjà vu is benign in the general population, rare neuropsychological cases with persistent déjà vu have been described in the literature. We report the case of MN, a 25-year-old woman, who suffered a cerebral haemorrhage in the right thalamo-callosal region and experienced recurrent déjà vu episodes. Through clinical interviews and memory tasks related to déjà vu, we assumed that source memory errors and an inappropriate feeling of familiarity (measured by the number of false recognitions) were critically involved in MN's déjà vu. Based on this, we developed the first neuropsychological intervention dedicated to déjà vu. The rationale was to train MN to detect elements that could produce an inappropriate feeling of familiarity and to promote metacognitive awareness about déjà vu. This intervention was effective at reducing the frequency of déjà vu episodes in MN's daily life, as well as the number of false recognitions in memory tasks. In addition to its clinical contribution, this single-case study contributes to the limited literature on patients whose déjà vu is not related to epileptic abnormalities and medial temporal brain damage, and provide supportive evidence of the role of an erroneous feeling of familiarity and of metacognitive processes in déjà vu.

fMRI evidence supporting the role of memory conflict in the déjà vu experience.

Attempts to generate déjà vu experimentally have largely focused on engineering partial familiarity for stimuli, relying on an ensuing, but unprompted evaluation of conflict to generate the experience. Without verification that experimentally-generated familiarity is accompanied by the awareness of stimulus novelty, these experimental procedures potentially provide an incomplete déjà vu analogue. We used a modified version of the Deese-Roediger-McDermott (DRM) false memory procedure to generate both familiarity and novelty within a déjà vu analogue - we coupled experimentally-generated familiarity with cues indicating that the familiarity was erroneous, using this additional source of mnemonic information to generate cognitive conflict in our participants. We collected fMRI and behavioural data from 21 participants, 16 of whom reported déjà vu. Using univariate contrasts we identified brain regions associated with mnemonic conflict, including the anterior cingulate cortex, medial prefrontal cortex and parietal cortex. This is the first experiment to image an analogue of the déjà vu experience in healthy volunteers. The increased likelihood of déjà vu reports to DRM critical lures correctly identified as "new", and the activation of neural substrates supporting the experience of cognitive conflict during déjà vu, suggest that the resolution of memory conflict may play an integral role in déjà vu.