PHYSIOLOGIC AND PHARMACOLOGIC STUDIES IN EPILEPSY

患者接受视频脑电监测以 确定癫痫发作类型和病灶定位。正电子发射 断层扫描(PET)和磁共振成像(MRI)是 用于研究大脑的新陈代谢、血液流动和结构。我们 已经发现，海马体体积同侧 癫痫患者的致痫区域明显缩小 癫痫与对照组相比。此外，平均同侧 丘脑、尾状核和双侧晶状体体积显著增加 癫痫患者与对照组相比较小。。 这些结果表明，医学上难治性的颞叶癫痫 与脑结构外的体积损失有关 可能牵涉到海马体。病理生理学 这些发现的意义尚不清楚。它们可能与 这种疾病的潜在病因。然而，体积损失 可能反映了由于这些结构涉及 反复发作活动。我们还发现癫痫的持续时间有 与同侧海马结构(HF)有显著关系 体积和同侧/对侧比。有以下病史的病人 持续的复杂热性惊厥(FS)同侧心衰较小 体积和同侧/对侧比率比无A FS的历史。发病年龄或扫描年龄的影响不显著。 有FS病史的患者没有较早的癫痫发作年龄 起病或持续时间长于无FS病史的患者。一个 FS病史可以预测我们患者心力衰竭萎缩的严重程度。 我们的研究表明，在最初的侮辱之后，进行性心力衰竭 持续性癫痫患者可能会出现损害。我们是 安慰剂双盲对照研究 低频(1/秒)经颅磁刺激(TMS) 关于复杂部分性癫痫发作的频率。动物研究 提示低频率TMS可能会导致长期抑郁 神经元的兴奋性。癫痫发作得不到控制的患者 通过目前可用的抗癫痫药物，并有癫痫发作的重点 通过视频本地化-脑电监测正在登记中。在 在安慰剂状态下，磁线圈被指向远离 癫痫发作的焦点。

Patients undergo video-EEG monitoring to determine seizure type and focus localization. Positron emission tomography (PET) and magnetic resonance imaging (MRI) are used to study cerebral metabolism, blood flow, and structure. We have found that hippocampal volumes ipsilateral to the epileptogenic zone were significantly smaller in the patients with epilepsy as compared to controls. In addition, mean ipsilateral thalamic, caudate and bilateral lenticular volumes were significantly smaller in the patients with epilepsy as compared to controls. . These results show that medically intractable temporal lobe epilepsy is associated with volume loss in brain structures outside the presumably involved hippocampus. The pathophysiologic significance of these findings are unclear. They could be related to the underlying etiology of the disorder. However, the volume loss may reflect damage due to the involvement of these structures in recurrent seizure activity. We also found that epilepsy duration had a significant relation to ipsilateral hippocampal formation (HF) volume and ipsilateral/contralateral ratio. Patients with a history of prolonged complex febrile seizures (FS) had smaller ipsilateral HF volume and ipsilateral/contralateral ratio than patients without a history of FS. The effect of age at onset or scan was not significant. Patients with a history of FS did not have earlier age at epilepsy onset or longer duration than those without a history of FS. A history of FS predicted the severity of HF atrophy in our patients. Our study suggests that, after an initial insult, progressive HF damage may occur in patients with persistent seizures. We are conducting a double-blind placebo controlled study of the effect of low-frequency (1/second) transcranial magnetic stimulation (TMS) on the frequency of complex partial seizures. Animal studies suggest that low frequency TMS may induce long-term depression of neuronal excitability. Patients whose seizures are not controlled by currently available anti- epileptic drugs, and have a seizure focus localized by video-EEG monitoring are being enrolled. In the placebo condition, the magnetic coil is directed away from the seizure focus.