EFFECT OF TEMPORAL LOBECTOMY ON SENSORY DEFICITS IN TEMPORAL LOBE EPILEPSY (TLE)

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。本方案的假设是颞叶癫痫（TLE）是一种网络疾病，涉及解剖学和功能上远离癫痫发作病灶的大脑区域。发作焦点可导致整个网络在间歇状态，即癫痫发作之间的功能障碍。具体目的如下：1)利用基本心理物理技术确定3种感觉模式间期知觉缺陷的程度和严重程度。2)确定刺激时间特征，特别是持续时间，对观察到的心理物理决定的知觉障碍的影响。3)记录去除癫痫焦点对知觉能力的影响。通过与研究人员的电话访谈，对符合纳入和排除标准的潜在受试者进行预先筛选。40名单侧难治性TLE患者和20名神经正常对照者将接受一系列神经心理学和感知心理物理测试。对照受试者将对所有任务进行一次测试；TLE受试者将进行三次测试：1)在服用常规抗癫痫药物（AED，初始测试）时进行基线评估，2)在临床指征期间大量或完全停用AED后，住院视频脑电图监测（非AED测试），以及3)手术后6个月或最终不进行手术的患者在初始测试后6个月（最终测试）。在测试的第一天，在所有三个测试阶段测量TLE受试者的AED水平。所有的心理物理测试都是无痛和非侵入性的。视觉任务包括看着电脑屏幕上的刺激物。听觉刺激通过高质量的耳机以舒适的音量呈现。触觉刺激以低或中等力度应用于受试者的指尖。主要结果测量将包括比较以下组在各种测试中的表现：TLE受试者-初始对照与正常对照，2)配对最终对照与初始对照，3)配对非aed与初始对照。次要结果测量将包括与手或耳对侧癫痫发作的初始表现相比，手或耳对侧癫痫发作的初始表现（视觉任务将双眼执行）。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The hypothesis of this protocol is that temporal lobe epilepsy (TLE) is a network disease, involving brain regions anatomically and functionally distant from the seizure focus. The seizure focus can cause dysfunction throughout the network in the interictal state, i.e., between seizures. The specific aims are as follows: 1) To define the extent and severity of interictal perceptual deficits in 3 sensory modalities using basic psychophysical techniques. 2) To determine the effect of stimulus temporal features, specifically duration, on observed psychophysically-determined perceptual impairments. 3) To document the effect of removing the seizure focus on perceptual abilities. Potential subjects will be prescreened for meeting the inclusion and exclusion criteria by telephone interview with research personnel. Forty patients with unilateral, medically intractable TLE and 20 neurologically normal controls will undergo a battery of neuropsychological and perceptual psychophysical tests. Control subjects will be tested once on all tasks; TLE subjects will be tested three times: 1) baseline assessment while taking their usual anti-epileptic drugs (AEDs, initial test), 2) after substantial or complete AED withdrawal during clinically indicated, inpatient video-EEG monitoring (non-AED test), and 3) 6 months after surgery or 6 months after initial testing for those patients who ultimately do not have surgery (final test). AED levels in TLE subjects will be measured during all three testing sessions, on the first day of testing. All of the psychophysical tests are painless and non-invasive. Visual tasks involve looking at stimuli on a computer screen. Auditory stimuli are presented through high-quality headphones at a comfortable volume. Tactile stimuli are applied to the subject's fingertip with low or moderate force. Primary outcome measures will include comparing performance on the various tests between the following groups: TLE subjects - initial to normal controls, 2) paired final to initial, and 3) paired non-AED to initial. Secondary outcome measures will include initial performance on psychophysical tasks with the hand or ear contra lateral to side of seizure onset compared to hand or ear ipsilateral to side of seizure onset (visual tasks will be performed binocularly).