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  • Title: Cortical excitability varies upon ictal onset patterns in neocortical epilepsy: a cortico-cortical evoked potential study.
    Author: Enatsu R, Piao Z, O'Connor T, Horning K, Mosher J, Burgess R, Bingaman W, Nair D.
    Journal: Clin Neurophysiol; 2012 Feb; 123(2):252-60. PubMed ID: 21802356.
    Abstract:
    OBJECTIVE: To better understand pathological neuronal excitation in epilepsy by comparing cortico-cortical evoked potential (CCEP) responses in regions with different ictal onset patterns: focal paroxysmal fast (PF) and repetitive spiking (RS). METHODS: Fourteen patients undergoing invasive monitoring (six patients with PF and eight with RS) were studied with CCEPs. A repetitive 1 Hz bipolar electrical stimulus was applied to both the ictal onset region (iCCEP) and to a control region (nCCEP) and CCEPs were recorded from the surrounding electrodes. The two groups were compared by subtracting the amplitude of nCCEP from that of iCCEP (CCEP(ictal-control)) at each stimulus intensity, and then normalizing the amplitudes of iCCEP at maximum stimulus intensity by dividing by nCCEP (CCEP(ictal/control)). RESULTS: The CCEP response to stimulation in the ictal onset region was significantly larger than to control stimulation for both ictal patterns (paroxysmal fast: P=0.02, repetitive spiking: P<0.01), with repetitive spiking group amplitudes higher than the paroxysmal fast group (CCEP(ictal-control): P<0.01 and CCEP(ictal/control): P=0.04). CONCLUSIONS: Pro-epileptic excitability is more accentuated in regions showing an ictal repetitive spiking pattern than a paroxysmal fast pattern. SIGNIFICANCE: These findings confirm in a new way that cortical excitability varies depending on the ictal onset pattern.
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