Basic science and clinical aspects of procaine HCl as a limbic system excitant

The literature in animals and humans which indicate that systemic procaine HCl activates limbic tissue is reviewed. Studies in cats which suggest that procaine excites limbic cells by reducing neural inhibition are then described. Evidence that power spectral analysis of high frequency EEG bands (omega or 31-55 cps) in the temporal cortical EEG reflects degree of limbic (amygdala) excitation in animals and humans is reviewed. Studies in cats are described which show that procaine selectively increases omega band activity in the amygdala and temporal cortex in a dose related fashion which parallels dose related increases in amygdaloid neural activity. Preliminary results of combining intravenous procaine and omega band analysis of scalp EEG in humans to predict therapeutic response to carbamazepine in borderline personality and affective disorder patients are then described. The effects of procaine on omega are compared to the effects of direct electrical stimulation of human limbic system in complex partial seizure patients undergoing assessment for temporal lobectomy. The results tentatively support the hypothesis that some psychiatric patients have hyperexcitable limbic systems, and those that do, show a positive behavioural response to carbamazepine.