Transcranial magnetic stimulation (TMS) of the human brain is mainly used for the diagnosis of diseases with disturbed central motor conduction. Recent studies revealed controversial results concerning the possibility of a TMS-induced specific activation of epileptogenic foci in patients with localization-related epilepsies, which would make TMS an additional diagnostic tool for the presurgical localization of the primary epileptogenic zone. We applied TMS to 19 patients with complex-partial seizures and investigated its effects and safety. In 12 patients we performed TMS during scalp electroencephalogram (EEG) recordings. The remaining 7 patients with localization-related epilepsies of mesiobasal limbic seizure origin underwent EEG with additionally implanted foramen-ovale-electrodes (FOE). We did not notice any significant spike activation and even observed bilateral reduction of epileptic activity in some patients. On the contrary, hyperventilation induced a marked activation of the epileptic focus. Our findings support that TMS is safe since adverse effects did not occur. However, due to possible safety hazards, TMS in epileptic patients still requires cautious application until more data will be available.
1. The present study is based on the demonstration (8, 9) that the relationship between mean interval (MI) and standard deviation (SD) for stimulus-driven activity recorded from SI neurons is well fitted by the linear equation SD = a X MI + b and on the observations that the values of the slope (a) and y intercept (b) parameters of this relationship are independent of stimulus conditions and may vary widely from one neuron to the next (8). 2. A criterion for the discriminability of two different mean firing rates requiring that the mean intervals of their respective interspike interval (ISI) distributions be separated by a fixed interval (expressed in SD units) is developed and, on the basis of this criterion, a graphical display of the capacity of a neuron with a known SD-MI relationship to reflect a change in stimulus conditions with a change in mean firing rate is derived. Using this graphical approach, it is shown that the parameters of the SD-MI relationship for a single neuron determine a range of firing frequencies, within which that neuron exhibits the greatest capacity to signal differences in stimulus conditions using a frequency code. 3. The discrimination criterion is modified to incorporate the changes in the symmetry of the ISI distribution observed to accompany changes in mean firing rate. It is shown that, although the observed symmetry changes do influence the capacity of a cortical neuron to signal a change in stimulus conditions with a change in mean firing rate, they do not alter the range of firing rates (determined by the parameters of the SD-MI relationship) within which the capacity for discrimination is maximal. 4. The maximal number of firing levels that can be distinguished by a somatosensory cortical neuron (using the same discrimination criterion described above) discharging within a specified range of mean frequencies also is demonstrated to depend on the parameters of the linear equation which relates SD to MI. 5. Two approaches based on the t test for differences between two means are developed in an attempt to ascertain the minimum separation of the mean intervals of the ISI distributions necessary for two different mean firing rates to be discriminated with 80% certainty.
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