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NEUROLOGY 2006;67:1646-1651
© 2006 American Academy of Neurology

Cortical excitability predicts seizures in acutely drug-reduced temporal lobe epilepsy patients

M. -A.S.Y. Wright, MSc, M. Orth, MD, PhD, P. N. Patsalos, FRCPath, PhD, S.J.M. Smith, FRCP and M. P. Richardson, FRCP, PhD

From the Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, and National Hospital for Neurology and Neurosurgery, University College London NHS Trust, UK.

Address correspondence and reprint requests to Dr Richardson, Box 29, Institute of Neurology, Queen Square, London WC1N 3BG, UK; e-mail: m.richardson{at}ion.ucl.ac.uk

Objective: To test the hypothesis that cortical excitability changes prior to seizures, using transcranial magnetic brain stimulation (TMS).

Methods: We studied 18 patients with unilateral temporal lobe epilepsy (TLE) twice using TMS: prior to (day 1) and following (day 3) reduction of antiepileptic drugs in a monitored inpatient setting. Short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) were measured. Time since most recent seizure prior to day 1, and time until next seizure after day 3, were recorded.

Results: On day 1, prior to antiepileptic drug withdrawal, there were no correlations with recent or next seizures. On day 3, patients who had seizures in the subsequent 48 hours had weaker SICI and ICF in the hemisphere ipsilateral to seizure onset, vs patients who did not have seizures in the next 48 hours (p = 0.033). Additionally on day 3, there was a strong correlation between the difference between ICF and SICI in the ipsilateral hemisphere and time to next seizure (p < 0.001).

Conclusions: Change in cortical excitability, measured with transcranial magnetic brain stimulation, may reflect a long-lasting and widespread pre-ictal state.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the November 14 issue to find the title link for this article.

M.P.R. is funded by the Medical Research Council.

Disclosure: The authors report no conflicts of interest.

Received September 14, 2005. Accepted in final form June 29, 2006.






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