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NEUROLOGY 2004;63:2051-2055
© 2004 American Academy of Neurology

Cortical excitability in drug-naive patients with partial epilepsy

A cross-sectional study C. Varrasi, MD, C. Civardi, MD, C. Boccagni, MD, M. Cecchin, MD, R. Vicentini, MD, F. Monaco, MD and R. Cantello, MD, PhD

From the Department of Medical Sciences, Section of Neurology, Università del Piemonte Orientale "A. Avogadro," Novara, Italy.

Address correspondence and reprint requests to Dr. R. Cantello, Dipartimento di Scienze Mediche, Via Solaroli 17, 28100 Novara, Italy; e-mail: cantello{at}med.unipmn.it

Objective: To use paired-pulse transcranial magnetic stimulation (TMS) to investigate cortical excitability in drug-naive patients with partial epilepsy.

Methods: Twenty-one drug-naive patients with partial epilepsy and 15 control subjects were studied. The relaxed threshold to TMS, the central silent period, and the intracortical inhibition/facilitation were measured. Statistics implied cluster analysis methods. Also assessed were the patient interictal EEG epileptiform abnormalities (EAs) on a semiquantitative basis. Then the TMS was contrasted to the clinical and EEG findings, using {chi}2 or Fisher exact tests.

Results: One-third of the patients made up a "pathologic" cluster with a disrupted intracortical inhibition (p < 0.01). Two-thirds had a normal inhibition. Interictal EAs predominated in the pathologic cluster, for frequency (p < 0.04), duration (p < 0.04), and focality (p < 0.02).

Conclusions: Intracortical inhibition, which was impaired in one-third of the patients, reflects {gamma}-aminobutyric acid (GABA) activity within cortical area 4. Defective GABA inhibition is a typical pathogenic factor in partial epilepsy. Transcranial magnetic stimulation proved able to detect it. The weaker cortical inhibition had a direct relation to the severity of interictal epileptiform abnormalities.

Received March 31, 2004. Accepted in final form August 16, 2004.




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