Kim Jee Hyun, Lee Hyang Woon, Cohen Leonardo G, Park Kee-Duk, Choi Kyoung-Gyu
Department of Neurology, Ewha Womans University, Seoul, Korea.
Epilepsia. 2008 Jan;49(1):117-24. doi: 10.1111/j.1528-1167.2007.01231.x. Epub 2007 Aug 2.
To gain insight into the mechanisms underlying poststroke epilepsy (PSE), we evaluated motor cortical function in chronic stroke patients with (N = 18) and without (N = 18) PSE.
We measured resting motor threshold (RMT), motor evoked potential (MEP) amplitudes, cortical silent period (CSP), intracortical inhibition (ICI), influenced by GABAergic neurotransmission, and intracortical facilitation (ICF), influenced by glutamatergic activity, to transcranial magnetic stimulation.
We found (1) larger MEP amplitudes and ICF, in the affected than unaffected hemispheres of patients in the PSE group but not in patients without epilepsy, and (2) comparably higher RMT and longer CSP in the absence of differences in ICI, H-reflexes or F-waves in the affected and unaffected hemispheres of both PSE and non-PSE patients.
Enhanced cortical excitability in the affected hemisphere, possibly related to increased glutamatergic activity, could be one of the mechanisms contributing to the development of poststroke epilepsy.
为深入了解中风后癫痫（PSE）的潜在机制，我们评估了患有PSE（N = 18）和未患PSE（N = 18）的慢性中风患者的运动皮质功能。
我们测量了经颅磁刺激的静息运动阈值（RMT）、运动诱发电位（MEP）幅度、皮质静息期（CSP）、受γ-氨基丁酸能神经传递影响的皮质内抑制（ICI）以及受谷氨酸能活动影响的皮质内易化（ICF）。
我们发现，（1）PSE组患者患侧半球的MEP幅度和ICF大于未患侧半球，但无癫痫的患者未出现此情况；（2）PSE患者和非PSE患者患侧与未患侧半球的ICI、Hoffmann反射（H反射）或F波无差异，但RMT相对较高，CSP较长。
患侧半球皮质兴奋性增强，可能与谷氨酸能活动增加有关，这可能是导致中风后癫痫发生的机制之一。
