sLORETA Source Localisation of Visual Mismatch Negativity in Dyslexic Children During Malay Orthographical Lexicon Stimulations.

BACKGROUND: While there are studies on visual lexical processing in other languages among dyslexics, no studies were done in the Malay language. The origin of visual lexical processing might be different in the Malay language. We aimed to detect the source localisation of visual mismatch negativity (vMMN) during Malay orthographic lexicon stimulations, employing an event-related potential (ERP) study. METHODS: Twelve dyslexic and twelve non-dyslexic children participated in this study. They pushed button '1' when they saw real (meaningful) Malay words and button '2' for pseudowords (meaningless). The source localisation of vMMN was performed in the grand average waveform by applying the standardised low-resolution brain electromagnetic tomography (sLORETA) method using Net Station software. RESULTS: Left occipital (BA17) and left temporal (BA37) lobes were activated during real words in the non-dyslexic and dyslexic children, respectively. During pseudowords, BA18 and BA17 areas of the left occipital lobe were activated in the non-dyslexic and dyslexic children, separately. vMMN sources were found at the left temporal (BA37) and right frontal (BA11) lobes in non-dyslexic and dyslexic children, respectively. CONCLUSION: Right frontal lobe is the decision-making area where vMMN source was found in dyslexic children. We concluded that dyslexic children required the decision-making area to detect Malay real and pseudowords.

Post-Attentive Integration and Topographic Map Distribution During Audiovisual Processing in Dyslexia: A P300 Event-Related Component Analysis.

BACKGROUND: Research on audiovisual post-attentive integration has been carried out using a variety of experimental paradigms and experimental groups but not yet studied in dyslexia. We investigated post-attentive integration and topographic voltage distribution in children with dyslexia by analysing the P300 event-related potential (ERP) component. METHODS: We used a 128-child ERP net for the ERP experiment. Two types of stimuli were presented as either congruent or incongruent stimuli. Congruent stimuli included a matching auditory sound with an animal image, whereas incongruent stimuli included unmatched animal sounds. A total of 24 age-matched children were recruited in the control (n = 12) and dyslexia (n = 12) groups. Children pressed button '1' or '2' when presented with congruent or incongruent stimuli, respectively. The P300 amplitudes and latencies with topographic voltage distribution were analysed for both groups. RESULTS: The dyslexia group evoked significantly higher P300 amplitudes at the T4 area than the control group. No significant differences were found in cases of P300 latency. Moreover, the dyslexia group demonstrated a higher intensity of P300 voltage distribution in the right parietal and left occipital areas than the control group. CONCLUSION: Post-attentive integration for children with dyslexia is higher and that this integration process implicated the parietal and occipital areas.

Role of Pre-Synaptic NMDA Receptors in the Modulation of Inhibitory Synaptic Transmission in Sensory-Motor and Visual Cortical Pyramidal Neurons in Brain Slices of Young Epileptic Mice.

BACKGROUND: Previous studies from animal models have shown that pre-synaptic NMDA receptors (preNMDARs) are present in the cortex, but the role of inhibition mediated by preNMDARs during epileptogenesis remains unclear. In this study, we wanted to observe the changes in GABAergic inhibition through preNMDARs in sensory-motor and visual cortical pyramidal neurons after pilocarpine-induced status epilepticus. METHODS: Using a pilocarpine-induced epileptic mouse model, sensory-motor and visual cortical slices were prepared, and the whole-cell patch clamp technique was used to record spontaneous inhibitory post-synaptic currents (sIPSCs). RESULTS: The primary finding was that the mean amplitude of sIPSC from the sensory-motor cortex increased significantly in epileptic mice when the recording pipette contained MK-801 compared to control mice, whereas the mean sIPSC frequency was not significantly different, indicating that post-synaptic mechanisms are involved. However, there was no significant pre-synaptic inhibition through preNMDARs in the acute brain slices from pilocarpine-induced epileptic mice. CONCLUSION: In the acute case of epilepsy, a compensatory mechanism of post-synaptic inhibition, possibly from ambient GABA, was observed through changes in the amplitude without significant changes in the frequency of sIPSC compared to control mice. The role of preNMDAR-mediated inhibition in epileptogenesis during the chronic condition or in the juvenile stage warrants further investigation.

Hormonal Influences on Cognitive Function.

This article examines how hormonal changes may affect the neuronal networking and mechanisms of cognitive function. Hormones are the chemical regulators of the human body and function critically to maintain various processes, such as growth, emotions and even cognition. Numerous studies have examined the relationship between hormonal effects and cognitive function; these studies have investigated different factors, such as aging, pregnancy, post-natal states, emotions and stress. Different types of hormones produce different outcomes for the human body and mind. Hormones may also contribute to both positive and negative outcomes, depending on whether the hormone levels are too low or too high. To investigate the hormonal effects on cognitive function, the sources of localisation must be localised, so that the neuronal network can be realised. Furthermore, cognitive function does not rely on a specific brain region but is determined by the neuronal network interactions. Thus, it is worthwhile to know the neural mechanisms behind cognitive functions that are affected by hormones.

Trkb-IP3 Pathway Mediating Neuroprotection in Rat Hippocampal Neuronal Cell Culture Following Induction of Kainic Acid.

BACKGROUND: Following brain injury, development of hippocampal sclerosis often led to the temporal lobe epilepsy which is sometimes resistant to common anti-epileptic drugs. Cellular and molecular changes underlying epileptogenesis in animal models were studied, however, the underlying mechanisms of kainic acid (KA) mediated neuronal damage in rat hippocampal neuron cell culture alone has not been elucidated yet. METHODS: Embryonic day 18 (E-18) rat hippocampus neurons were cultured with poly-L-lysine coated glass coverslips. Following optimisation, KA (0.5 µM), a chemoconvulsant agent, was administered at three different time-points (30, 60 and 90 min) to induce seizure in rat hippocampal neuronal cell culture. We examined cell viability, neurite outgrowth density and immunoreactivity of the hippocampus neuron culture by measuring brain derived neurotrophic factor (BDNF), γ-amino butyric acid A (GABAA) subunit α-1 (GABRA1), tyrosine receptor kinase B (TrkB), and inositol trisphosphate receptor (IP3R/IP3) levels. RESULTS: The results revealed significantly decreased and increased immunoreactivity changes in TrkB (a BDNF receptor) and IP3R, respectively, at 60 min time point. CONCLUSION: The current findings suggest that TrkB and IP3 could have a neuroprotective role which could be a potential pharmacological target for anti-epilepsy drugs.

Neural activation patterns and connectivity in visual attention during Number and Non-number processing: An ERP study using the Ishihara pseudoisochromatic plates.

Visual cognitive function is important to build up executive function in daily life. Perception of visual Number form (e.g., Arabic digit) and numerosity (magnitude of the Number) is of interest to cognitive neuroscientists. Neural correlates and the functional measurement of Number representations are complex occurrences when their semantic categories are assimilated with other concepts of shape and colour. Colour perception can be processed further to modulate visual cognition. The Ishihara pseudoisochromatic plates are one of the best and most common screening tools for basic red-green colour vision testing. However, there is a lack of study of visual cognitive function assessment using these pseudoisochromatic plates. We recruited 25 healthy normal trichromat volunteers and extended these studies using a 128-sensor net to record event-related EEG. Subjects were asked to respond by pressing Numbered buttons when they saw the Number and Non-number plates of the Ishihara colour vision test. Amplitudes and latencies of N100 and P300 event related potential (ERP) components were analysed from 19 electrode sites in the international 10-20 system. A brain topographic map, cortical activation patterns and Granger causation (effective connectivity) were analysed from 128 electrode sites. No major significant differences between N100 ERP components in either stimulus indicate early selective attention processing was similar for Number and Non-number plate stimuli, but Non-number plate stimuli evoked significantly higher amplitudes, longer latencies of the P300 ERP component with a slower reaction time compared to Number plate stimuli imply the allocation of attentional load was more in Non-number plate processing. A different pattern of asymmetric scalp voltage map was noticed for P300 components with a higher intensity in the left hemisphere for Number plate tasks and higher intensity in the right hemisphere for Non-number plate tasks. Asymmetric cortical activation and connectivity patterns revealed that Number recognition occurred in the occipital and left frontal areas where as the consequence was limited to the occipital area during the Non-number plate processing. Finally, the results displayed that the visual recognition of Numbers dissociates from the recognition of Non-numbers at the level of defined neural networks. Number recognition was not only a process of visual perception and attention, but it was also related to a higher level of cognitive function, that of language.

How Much We Think of Ourselves and How Little We Think of Others: An Investigation of the Neuronal Signature of Self-Consciousness between Different Personality Traits through an Event-Related Potential Study.

BACKGROUND: Previous studies have revealed that self-related tasks (items) receive more attention than non-self-related, and that they elicit event-related potential (ERP) components with larger amplitudes. Since personality has been reported as one of the biological correlates influencing these components, as well as our behavioural differences, it is important to examine how it affects our self-consciousness in relation to tasks of varied relevance and the neurological basis. METHODS: A total of 33 male and female undergraduate Malaysian medical students of Universiti Sains Malaysia (USM) participated in the study. The participants were divided into two groups, Ambivert (n = 18) and Extravert (n = 15) groups, using the USM personality inventory questionnaire. In the ERP experiment, squares containing standard stimuli of any word other than self and non-self-related nouns (e.g., Bola, Gigi, Anak, etc.; in English: Ball, Teeth, Kids, etc., respectively), those containing self-related pronouns (Saya, Kami or Kita; in English: I, Us or We, respectively), and non-self-related pronouns (Dia, Anda or Mereka; in English: He/She, You or They, respectively), were shown 58%, 21% and 21% of the time, respectively, in a three-stimulus visual oddball paradigm. All words were presented in Bahasa Melayu. The participants were instructed to press 1 for self and 2 for non-self, and ignore standard stimuli. RESULTS: Comparison of both N200 and P300 amplitudes for self-related and non-self-related pronouns in the Extravert group revealed significant differences at seven electrode sites, with self-related having larger amplitude at anterior electrodes and less at posterior. This was not seen in the Ambivert group. CONCLUSION: The present study suggests that self-relevant pronouns are psychologically more important to extraverts than to ambiverts; hence, they have more self-awareness. This may be due to large amount of dopamine in the brains of extraverts, which is more concentrated in the frontal lobe.

Influence of education level on design-induced N170 and P300 components of event related potentials in the human brain.

Simple geometric and organic shapes and their arrangement are being used in different neuropsychology tests for the assessment of cognitive function, special memory and also for the therapy purpose in different patient groups. Until now there is no electrophysiological evidence of cognitive function determination for simple geometric, organic shapes and their arrangement. Then the main objective of this study is to know the cortical processing and amplitude, latency of visual induced N170 and P300 event related potential components on different geometric, organic shapes and their arrangement and different educational influence on it, which is worthwhile to know for the early and better treatment for those patient groups. While education influenced on cognitive function by using auditory oddball task, little is known about the influence of education on cognitive function induced by visual attention task in case of the choice of geometric, organic shapes and their arrangements. Using a 128-electrode sensor net, we studied the responses of the choice of the different geometric and organic shapes randomly in experiment 1 and their arrangements in experiment 2 in the high, medium and low education groups. In both experiments, subjects push the button "1" or "2" if like or dislike, respectively. Total 45 healthy subjects (15 in each group) were recruited. ERPs were measured from 11 electrode sites and analyzed to see the evoked N170/N240 and P300 ERP components. There were no differences between like and dislike in amplitudes even in latencies in every stimulus in both experiments. We fixed geometric shapes and organic shapes stimuli only, not like and dislike. Upon the stimulus types, N170 ERP component was found instead of N240, in occipito-temporal (T5, T6, O1 and O2) locations where the amplitude is the highest at O2 location and P300 was distributed in the central (Cz and Pz) locations in both experiments in all groups. In experiment 1, significant low amplitude and non-significant larger latency of the N170 component are found out at O1 location for both stimuli in low education group comparing medium education groups, but in experiment 2, there is no significant difference between stimuli among groups in amplitude and latency. In both experiments, P300 component was found in Cz and Pz locations though the amplitudes are higher at Cz than Pz areas. In experiment 1, medium education group evoked significantly (geometric shape stimuli, P = 0.05; organic shape stimuli, P = 0.02) higher amplitude of P300 component comparing low education group at Cz location. Whereas, there is no significant difference of amplitudes among groups across stimuli in Cz and Pz locations in experiment 2. Latencies have no significant differences in both experiments among groups also, but longer latency are found in low education group at Cz location comparing medium education group, though not significant. We conclude that simple geometric shapes, organic shapes and their arrangements evoked visual N170 component at temporo-occipital areas with right lateralization and P300 ERP component at centro-parietal areas. Significant low amplitude of N170 and P300 ERP components and longer latencies during different shape stimuli in low education group prove that, low education significantly influence on visual cognitive functions in low education group.

Involvement of T-type Ca2+ channels in the potentiation of synaptic and visual responses during the critical period in rat visual cortex.

Neocortical neuronal circuits are refined by experience during the critical period of early postnatal life. The shift of ocular dominance in the visual cortex following monocular deprivation has been intensively studied to unravel the mechanisms underlying the experience-dependent modification. Synaptic plasticity is considered to be involved in this process. We previously showed in layer 2/3 pyramidal neurons of rat visual cortex that low-frequency stimulation-induced long-term potentiation (LTP) at excitatory synapses, which requires the activation of Ni(2+)-sensitive (R-type or T-type) voltage-gated Ca(2+) channels (VGCCs) for induction, shared a similar age and experience dependence with ocular dominance plasticity. In this study, we examined whether this LTP is involved in ocular dominance plasticity. In visual cortical slices, LTP was blocked by mibefradil, kurtoxin and R-(-)-efonidipine, T-type VGCC blockers, but not by SNX-482, an R-type VGCC blocker, indicating that LTP induction requires T-type VGCC activation. Mibefradil did not affect synaptic transmission even at a dose about 30 times higher than that required for LTP blockade. Therefore, this drug was used to test the effect of T-type VGCC blockade on ocular dominance shift produced by 6 days of monocular deprivation during the critical period using visual evoked potentials (VEPs). Although this monocular deprivation commonly produced both depression of deprived eye responses and potentiation of nondeprived eye responses, only the former change occurred when mibefradil was infused into the visual cortex during monocular deprivation. Mibefradil infusion produced no acute effects on VEPs. These results suggest that T-type VGCC-dependent LTP contributes to the experience-dependent enhancement of visual responses.

Brain-derived neurotrophic factor-mediated retrograde signaling required for the induction of long-term potentiation at inhibitory synapses of visual cortical pyramidal neurons.

High-frequency stimulation (HFS) induces long-term potentiation (LTP) at inhibitory synapses of layer 5 pyramidal neurons in developing rat visual cortex. This LTP requires postsynaptic Ca2+ rise for induction, while the maintenance mechanism is present at the presynaptic site, suggesting presynaptic LTP expression and the necessity of retrograde signaling. We investigated whether the supposed signal is mediated by brain-derived neurotrophic factor (BDNF), which is expressed in pyramidal neurons but not inhibitory interneurons. LTP did not occur when HFS was applied in the presence of the Trk receptor tyrosine kinase inhibitor K252a in the perfusion medium. HFS produced LTP when bath application of K252a was started after HFS or when K252a was loaded into postsynaptic cells. LTP did not occur in the presence of TrkB-IgG scavenging BDNF or function-blocking anti-BDNF antibody in the medium. In cells loaded with the Ca2+ chelator BAPTA, the addition of BDNF to the medium enabled HFS to induce LTP without affecting baseline synaptic transmission. These results suggest that BDNF released from postsynaptic cells activates presynaptic TrkB, leading to LTP. Because BDNF, expressed activity dependently, regulates the maturation of cortical inhibition, inhibitory LTP may contribute to this developmental process, and hence experience-dependent functional maturation of visual cortex.

Efficacy of low-dose, add-on therapy of clobazam (CLB) is produced by its major metabolite, N-desmethyl-CLB.

We evaluated the efficacy of low-dose, add-on therapy of CLB in adults with refractory epilepsy. 28 patients were included: 12 with temporal lobe epilepsy (TLE), 14 with extratemporal lobe epilepsy (ETLE) and 2 with symptomatic generalized epilepsy (SGE). CLB was added with the initial dose of 2.5 mg/day and increased to the optimal dose (mean, 5.6 mg/day). The mean observation period was 7.9 months. As compared with the baseline period, 14 out of 28 patients (50%) obtained an obviously good seizure control: 6 seizure free and 8 more than 50% of seizure reduction. The 14 patients comprised of 4 TLE, 8 ETLE and 2 SGE. In seizure type analysis, 26% of complex partial seizures (CPS), 64% of simple partial seizures (SPS) and 86% of generalized tonic-clonic seizures (GTC) showed a good control. Blood level of N-desmethyl-CLB in the steady state was higher in seizure-free group of 6 patients, and N-desmethyl-CLB blood level/dose per kg body weight correlated significantly to seizure control (p=0.0167). Our data show that even in low dose CLB was effective to patients with refractory epilepsy who had higher blood level of N-desmethyl-CLB.

Ipsilateral facial sensory and motor responses to basal fronto-temporal cortical stimulation: evidence suggesting direct activation of cranial nerves.

To clarify the generator mechanism of sensory and motor facial responses ipsilateral to electrical stimulation of the inferior fronto-temporal cortex in epilepsy patients. Out of 30 patients who have been evaluated with chronically implanted subdural electrodes for medically intractable partial seizure or brain tumor involving the basal frontal or temporal cortex, 4 patients (age ranging 24-57 years) showed sensory and motor responses in the ipsilateral face to high frequency electrical cortical stimulation of the inferior fronto-temporal cortex. We investigated motor evoked potentials (MEPs) in the facial muscle by single pulse stimulation in 2 out of 4 patients. Three patients showed both sensory symptoms and muscle contraction in the ipsilateral lower face when the orbitofrontal or basal temporal cortex was stimulated with 50 Hz electric current. One patient had only sensory symptoms in the lower face when ipsilateral basal temporal area was stimulated. MEPs at the left orbicularis oris muscle were constantly elicited with the onset latency of 7 ms throughout the stimulus rate of 2-30 Hz in 1 patient out of 2 patients was tested. In another patient, MEP onset latency was 3.0 ms with 11 Hz stimulation. With electrical stimulation of the basal fronto-temporal cortex, the ipsilateral facial twitch might occur through either the direct activation of the facial nerve by the current spread in the middle cranial fossa or through the mechanism similar to blink reflex.

Rapid recovery from coma with multifocal PLEDs in a patient with severe dementia and transient hypoxemia.

We report a patient with severe dementia who acutely developed transient coma following possible acute anoxic encephalopathy, and presented multifocal periodic lateralized epileptiform discharges (PLEDs) on EEG, who had a good recovery from the acute state. Two EEGs were recorded from this patient. In the first EEG taken immediately after admission, multifocal PLEDs were prominent, and the background activity consisted of low voltage, continuous and irregular theta activity (4-6 Hz). The patient recovered from coma (GCS-3) to the conscious state (GCS-15) within 14 hours and was not associated with newly developed focal or global neurological deficits except for stable severe dementia which had developed in the previous several years. Another EEG taken 5 days later showed disappearance of multifocal PLEDs. Transient appearance of multifocal PLEDs might represent at least the transient, vulnerability associated with underlying dementia in this particular patient. We concluded that multifocal PLEDs do not always indicate a poor outcome in patients with possible acute anoxic encephalopathy, and rapid diagnosis and appropriate treatment should be done even if the initial EEG shows multifocal PLEDs.

Clinical outcome of patients with SREDA (subclinical rhythmic EEG discharge of adults).

OBJECTIVE: To clarify the clinical significance of subclinical rhythmic EEG discharge of adults' (SREDA) by analyzing characteristics of SREDA and the outcome of patients based on retrospective analysis of EEG data base. METHODS: EEGs were recorded soon after the onset of patient's initial symptoms and repeatedly recorded at various intervals of 2-3 months in all 4 patients. Neurological findings, MRI and SPECT were also investigated. SUBJECTS: Out of 340 consecutive inpatient population who had EEGs, 4 patients (1.2%) showed SREDA. They had a diagnosis of syncope, transient global amnesia, generalized tonic-clonic seizure and right temporal lobe epilepsy for each. RESULTS: There was no consistent abnormality in the brain MRI, CT or SPECT among the 4 patients. The acute and transient symptoms disappeared and did not recur within the follow-up period of 28 months in any patient. In 2 patients SREDA disappeared in the follow-up EEG taken 7-14 days after the first EEG showing SREDA. In the other 2 patients, the follow-up EEGs taken 5 days after the first EEG with SREDA when clinical symptoms disappeared showed less frequent occurrence of SREDA. CONCLUSION: Being different from the previous reports suggesting the relation with cardiogenic insults or persistent ischemic abnormality, SREDA can occur in patients with various acute brain dysfunctions followed by a favorable clinical outcome.

Altered plasticity of the human motor cortex in Parkinson's disease.

Interventional paired associative stimulation (IPAS) to the contralateral peripheral nerve and cerebral cortex can enhance the primary motor cortex (M1) excitability with two synchronously arriving inputs. This study investigated whether dopamine contributed to the associative long-term potentiation-like effect in the M1 in Parkinson's disease (PD) patients. Eighteen right-handed PD patients and 11 right-handed age-matched healthy volunteers were studied. All patients were studied after 12 hours off medication with levodopa replacement (PD-off). Ten patients were also evaluated after medication (PD-on). The IPAS comprised a single electric stimulus to the right median nerve at the wrist and subsequent transcranial magnetic stimulation of the left M1 with an interstimulus interval of 25 milliseconds (240 paired stimuli every 5 seconds for 20 minutes). The motor-evoked potential amplitude in the right abductor pollicis brevis muscle was increased by IPAS in healthy volunteers, but not in PD patients. IPAS did not affect the motor-evoked potential amplitude in the left abductor pollicis brevis. The ratio of the motor-evoked potential amplitude before and after IPAS in PD-off patients increased after dopamine replacement. Thus, dopamine might modulate cortical plasticity in the human M1, which could be related to higher order motor control, including motor learning.

Cortical mechanisms of unilateral voluntary motor inhibition in humans.

While motor control is very often a goal-oriented event, little is known about the mechanisms underlying the termination of motor performance. To investigate what type of cortical activation underlies the muscle relaxation required to terminate the act, we performed single- and double-pulse transcranial magnetic stimulation (TMS) studies during voluntary muscle relaxation in nine normal volunteers. Subjects maintained a weak isometric contraction of the right first dorsal interosseous muscle (FDI), and either increased the level of contraction (Contraction), terminated the contraction (Relaxation), or maintained it (No-go) depending on a visual cue. Motor evoked potentials (MEP) and the silent period (SP) were recorded from the FDI during motor activity. To measure intra-cortical inhibition (ICI), we also performed double-pulse TMS, applying subthreshold conditioning stimuli at interstimulus intervals of 2 ms. When single-pulse TMS was given just prior to muscle relaxation (-21 to -70 ms), the MEP was reduced while the SP was unchanged. Intra-cortical inhibition was smaller just prior to the muscle relaxation. Unilateral voluntary muscle relaxation may not be associated with activation of the intracortical inhibitory system, but rather with the possible excitation of the corticospinal system, which can inhibit motoneurons disynaptically. These findings suggest that multiple inhibitory mechanisms act in diverse ways to achieve motor inhibition.

Processing of Japanese morphogram and syllabogram in the left basal temporal area: electrical cortical stimulation studies.

Language functions in the left basal temporal area (LBTA) were investigated using electrical cortical stimulation during functional mapping in six Japanese patients with refractory epilepsy. This study provides the first direct evidence that kana (Japanese syllabogram) is processed in the LBTA. Electrical stimulation of some areas within LBTA induced disturbance in overt reading of kana words only in the first trials, with no errors in the subsequent trials. By contrast, stimulation of the same area caused obvious disturbance in kana non-word reading in all trials. Since a kana word carries both meaning and sound while a kana non-word carries only sounds of a letter string, the contrasting results of partial and complete disturbance imply a possibility that there are two distinct pathways for kana reading: one dealing with both phonological and semantic aspects of the words and the other dealing only with phonological aspect. Kanji words (Japanese morphogram) and objects/pictures were found to be processed in an area different from the area for the kana non-word processing. Furthermore, the present study also identified the common area for processing kanji reading and object/picture naming. There were no errors in matching pictures with kanji words, indicating that concepts of pictures and meanings of kanji words were not interfered by the electrical stimulation of that area. The new insight provides a clue for partial description of processing pathways for language-related visual information in LBTA. Three types of information (morphological, phonological, and semantic) are conveyed together at some stages and are separated into different routes at some other stages.

Low-frequency repetitive transcranial magnetic stimulation for seizure suppression in patients with extratemporal lobe epilepsy-a pilot study.

We evaluated the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on seizure frequency in adult patients with medically intractable extratemporal lobe epilepsy (ETLE). Seven patients with medically intractable ETLE received low-frequency rTMS at 0.9 Hz, basically two sets of 15 min stimulation per day for five days in a week, with the stimulus intensity of 90% of resting motor threshold (RMT). The number of seizures during two weeks before and after the stimulation of one week was compared. Furthermore, RMT and active motor threshold (AMT) were measured before and after rTMS for each daily session. After low-frequency rTMS of one week, the frequency of all seizure types, complex partial seizures (CPSs) and simple partial seizures was reduced by 19.1, 35.9 and 7.4%, respectively. The patients with smaller difference between RMT and AMT before rTMS had higher reduction rate of CPSs. A favorable tendency of seizure reduction, though not statistically significant, during two weeks after low-frequency rTMS was demonstrated in medically intractable ETLE patients. As far as CPSs are concerned, smaller decrease of motor threshold by voluntary muscle contraction was associated with better response to rTMS.

Electric cortical stimulation suppresses epileptic and background activities in neocortical epilepsy and mesial temporal lobe epilepsy.

OBJECTIVE: To evaluate the suppressive effect of electric cortical stimulation upon the seizure onset zone and the non-epileptic cortex covered by subdural electrodes in patients with neocortical epilepsy and mesial temporal lobe epilepsy (MTLE). METHODS: Four patients with medically intractable focal epilepsy had implanted subdural electrodes for preoperative evaluation. Cortical functional mapping was performed by intermittently repeating bursts of electric stimulation, which consisted of 50 Hz alternating square pulse of 0.3 ms duration, 1-15 mA, within 5 s. The effect of this stimulation on the seizure onset zones and on the non-epileptic areas was evaluated by comparing spike frequency and electrocorticogram (ECoG) power spectra before and after stimulation. A similar comparison was performed in stimulation of 0.9 Hz of the seizure onset zones for 15 min. RESULTS: When the seizure onset zone was stimulated with high frequency, spike frequency decreased by 24.7%. Logarithmic ECoG power spectra recorded at stimulated electrode significantly decreased in 10-32 Hz band by high frequency stimulation of the seizure onset zone, and in 14-32 Hz band by high frequency stimulation of the non-epileptic area. Low frequency stimulation of the seizure onset zone produced 18.5% spike reduction and slight power decrease in 12-14 Hz. CONCLUSIONS: Both high and low frequency electric cortical stimulation of the seizure onset zone have a suppressive effect on epileptogenicity. Reduction of ECoG fast activities after electric cortical stimulation suggests the augmentation of inhibitory mechanisms in human cortex.

Effect of spatial attention on human sensorimotor integration studied by transcranial magnetic stimulation.

OBJECTIVE: Recent transcranial magnetic stimulation (TMS) studies showed that the sensory input can decrease the motor cortex excitability (afferent inhibition). To clarify the effect of attention on sensorimotor integration, we investigated the effect of spatial attention on afferent inhibition. METHODS: Right median nerve electrical stimulation followed, at variable delays (10-300 ms), by TMS over the left motor cortex was applied to 9 subjects, during 3 conditions; spatial attention to the right and left hand, and control (no attention) tasks. RESULTS: Inhibition of the motor evoked potential occurred at inter-stimulus interval of 20 and 100 ms, which was more was marked during spatial attention to the right than to the left hand. CONCLUSIONS: Enhancement of the afferent inhibition induced by spatial attention to the stimulated side is likely to reflect the interaction between attention and sensorimotor integration. SIGNIFICANCE: The spatial attention may modulate the sensorimotor integration studied by afferent inhibition of the MEP.