Single pulse electrical stimulation of the hippocampus is sufficient to impair human episodic memory.

We have used the single pulse electrical stimulation (SPES) technique to investigate whether more localized stimulation of the hippocampus can affect human episodic memory. A recognition memory test including words, object drawings, abstract drawings and unfamiliar faces was performed without stimulation (baseline) or synchronized with single 1 ms electrical pulses applied to the left, right or both hippocampi in 12 epileptic patients investigated with bilateral depth electrodes. No differences were found in memory performance between baseline and unilateral stimulation, either in the total score or in material-specific scores. In contrast, bilateral stimulation was associated with a pronounced decrease in the median of total memory scores (57%), and of material-specific sub-scores for words (38%), geometrical drawings (81%) and faces (100%). Additional study of stimulation at presentation of stimuli (encoding) versus the recognition memory (retrieval) test phase, showed reduction in memory only at encoding. The results provide causal evidence that the hippocampi are necessary for supporting episodic memory. The induction of memory deficits by bilateral stimulation with parameters that do not induce effects when applied unilaterally suggests that recognition memory can be processed independently by the hippocampus on either hemisphere.

Responses to single pulse electrical stimulation identify epileptogenesis in the human brain in vivo.

The aim of the present study was to investigate in vivo cortical excitability in the human brain. We studied 45 consecutive patients with refractory epilepsy in whom subdural or intracerebral electrodes were implanted for assessment prior to epilepsy surgery. We compared cortical responses to single pulse stimulation (up to 8 mA, 1 ms duration) in areas where seizure onset occurred, with responses recorded elsewhere. Two main types of responses were seen: (i) 'early responses', spikes and/or slow waves starting within 100 ms after the stimulus which were observed in most regions in all patients; and (ii) 'delayed responses', spikes or sharp waves occurring between 100 ms and 1 s after stimulation which were seen in some regions in 27 patients. The distributions of early and delayed responses were compared with the topography of seizure onset. Whereas early responses were seen in most regions and seem to be a normal response of the cortex to single pulse stimulation, the distributions of delayed responses were significantly associated with the regions where seizure onset occurred. We conclude that the presence of delayed responses can identify regions of hyperexcitable cortex in the human brain. The study of delayed responses may improve our understanding of the physiology and dynamics of neuronal circuits in epileptic tissue and may have an immediate clinical application in assessment of candidates for surgical treatment of epilepsy.