Changes in glutamate concentration, glucose metabolism, and cerebral blood flow during focal brain cooling of the epileptogenic cortex in humans
Changes in glutamate concentration, glucose metabolism, and cerebral blood flow during focal brain cooling of the epileptogenic cortex in humans
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DOI：
10.1111/epi.12600
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发表时间：
2014-05-01
期刊：
影响因子：
5.6
通讯作者：
Suzuki, Michiyasu
中科院分区：
文献类型：
--
作者：
Nomura, Sadahiro;Fujii, Masami;Suzuki, Michiyasu
目的近年来，脑局部降温(FBC)被提出作为一种治疗难治性癫痫的方法。然而，降温对癫痫分子基础的确切影响尚未阐明。因此，本研究的目的是评价FBC对难治性癫痫患者谷氨酸(Glu)浓度、脑血流量(CBF)和糖代谢的影响。方法9例患者在15℃下接受FBC 30min，然后进行皮质切除(n=6)或海马切除(n=3)。结果癫痫放电(ED)在降温期消失，在复温期再次出现。谷氨酸浓度在预冷期较高，在降温期降至51.2%(p=0.025)。甘油水平也有类似的下降(p=0.028)。乳酸浓度在预冷期较高，在降温期有所下降(下降21.3%；p=0.005)。血糖和丙酮酸水平在整个过程中保持不变。CBF的变化与ECoG观察到的变化是平行的。显著的是，FBC降低了内分泌、谷氨酸和甘油浓度。这证明了FBC的神经保护作用。我们的研究结果证实，FBC是治疗顽固性癫痫患者的合理和最佳选择。概述本文的PowerPoint幻灯片可在支持信息部分下载。
ObjectiveRecently, focal brain cooling (FBC) was proposed as a method for treating refractory epilepsy. However, the precise influence of cooling on the molecular basis of epilepsy has not been elucidated. Thus the aim of this study was to assess the effect of FBC on glutamate (Glu) concentration, cerebral blood flow (CBF), and glucose metabolism in patients with intractable epilepsy.MethodsNine patients underwent FBC at 15 degrees C for 30min prior to cortical resection (n=6) or hippocampectomy (n=3). Measurement of metabolites and CBF, as well as electrocorticography (ECoG), was performed.ResultsEpileptic discharge (ED), as observed by ECoG, disappeared in the cooling period and reappeared in the rewarming period. Glu concentrations were high during the precooling period and were reduced to 51.2% during the cooling period (p=0.025). Glycerol levels showed a similar decrease (p=0.028). Lactate concentration was high during the precooling period and was reduced during the cooling period (21.3% decrease; p=0.005). Glucose and pyruvate levels were maintained throughout the procedure. Changes in CBF were parallel to those observed by ECoG.SignificanceFBC reduced EDs and concentrations of Glu and glycerol. This demonstrates the neuroprotective effect of FBC. Our findings confirm that FBC is a reasonable and optimal treatment option for patients with intractable epilepsy. A PowerPoint slide summarizing this article is available for download in the Supporting Information section .