Gabapentin has come into clinical use as adjunctive therapy in the treatment of epilepsy. Designed to mimic gamma-aminobutyric acid (GABA), its mechanism of action remains elusive. In vivo measurements of GABA in human brain were made using 1H magnetic resonance spectroscopy. We used a 2.1-T magnetic resonance imager-spectrometer and an 8-cm surface coil to measure a 13.5-cm3 volume in the occipital cortex. GABA levels were measured in 14 patients enrolled in an open-lbel trial of gabapentin. GABA was elevated in patients taking gabapentin compared with 14 complex partial epilepsy patients, matched for antiepileptic drug treatment. Brain GABA levels appeared to be higher in patients taking high-dose gabapentin (3,300-3,600 mg/day) than in those taking standard doses (1,200-2,400 mg/day). Gabapentin appears to increase human brain GABA levels.

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The authors propose a Sociotechnical Systems Engineering (STSE) framework that elevates the requirements and concerns of external/global stakeholders to be on par with those of traditional system users and counters the argument that profit motivation should be the dominant factor when deciding which systems we should build. STSE offers a more complete perspective on what it means to deliver a balanced solution. The authors distill unique elements of Sociotechnical Systems Engineering (STSE) and an integrated framework. The framework serves as the foundation for ongoing discussion of opportunities and challenges associated with our evolving practice of SE. Traditional SE framework, practices and processes remain intact. STSE emphasizes the importance of accounting for societal considerations and hidden costs excluded from our current decision‐making consideration. Post‐deployment societal outcomes we experience may not lie in our ability to perform SE/STSE, but in the governing motivations as we do so.

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