Cortical Excitability in Temporal Lobe Epilepsy with Bilateral Tonic-Clonic Seizures
Cortical Excitability in Temporal Lobe Epilepsy with Bilateral Tonic-Clonic Seizures
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DOI：
10.1017/cjn.2020.267
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Lingli Hu;Houmin Yin;Linling Yang;Cong Chen;Chenmin He;Yi Chen;Junming Zhu;Yao Ding;
中科院分区：
文献类型：
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作者：
Lingli Hu;Houmin Yin;Linling Yang;Cong Chen;Chenmin He;Yi Chen;Junming Zhu;Yao Ding;
摘要：目的：我们采用双脉冲经颅磁刺激（TMS）研究单侧颞叶癫痫（TLE）的运动皮层兴奋性（CE）及其与双侧强直阵挛性发作（BTCS）的关系。方法：在这项横断面研究中，我们纳入了46例单侧TLE患者和16名年龄和性别匹配的健康对照。静息运动阈值（RMT）;短间期皮质内抑制（SICI，GABAA受体介导）;易化（ICF，GABAA受体介导），刺激间期（ISI）为2、5、10和15 ms;长间期皮质内抑制（LICI，GABAB受体介导），ISI为200-400 ms，通过成对脉冲TMS进行测量。比较对照组和TLE患者之间的差异，然后比较TLE亚组（无BTCS，罕见BTCS和频繁BTCS亚组）。结果如下：与对照组相比，TLE患者双侧半球RMT较高，SICI较低，LICI较高，同侧半球ICF较高。在频繁BTCS的患者中，与不频繁或无BTCS的患者相比，以参数依赖性方式发现同侧半球的皮质过度兴奋（SICI在刺激间隔为5 ms时降低，ICF在刺激间隔为15 ms时增加）。结论：我们的研究结果表明，运动皮层的超兴奋性在同侧半球的癫痫网络的活动BTCS患者，这是更广泛的比那些罕见的或没有BTCS的基础。
ABSTRACT: Objective: We investigated motor cortical excitability (CE) in unilateral temporal lobe epilepsy (TLE) and its relationship to bilateral tonic-clonic seizure (BTCS) using paired-pulse transcranial magnetic stimulation (TMS). Methods: In this cross-sectional study, we enrolled 46 unilateral TLE patients and 16 age-and sex-matched healthy controls. Resting motor thresholds (RMT); short-interval intracortical inhibition (SICI, GABAA receptor-mediated); facilitation (ICF, glutamatergic-mediated) with interstimulus intervals (ISIs) of 2, 5, 10, and 15 ms; and long-interval intracortical inhibition (LICI, GABAB receptor-mediated) with ISIs of 200–400 ms were measured via paired-pulse TMS. Comparisons were made between controls and patients with TLE, and then among the TLE subgroups (no BTCS, infrequent BTCS and frequent BTCS subgroup). Results: Compared with controls, TLE patients had higher RMT, lower SICI and higher LICI in both hemispheres, and higher ICF in the ipsilateral hemisphere. In patients with frequent BTCS, cortical hyperexcitability in the ipsilateral hemisphere was found in a parameter-dependent manner (SICI decreased at a stimulation interval of 5 ms, and ICF increased at a stimulation interval of 15 ms) compared with patients with infrequent or no BTCS. Conclusions: Our results demonstrate that motor cortical hyper-excitability in the ipsilateral hemisphere underlies the epileptogenic network of patients with active BTCS, which is more extensive than those with infrequent or no BTCS.