Journal
NEUROLOGY
Volume 77, Issue 9, Pages 904-910Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e31822c90f2
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Funding
- Deutsche Forschungsgemeinschaft [LA 1452/3-1]
- Bundesministerium fur Bildung und Forschung [01 EV 0703]
- Medical Research Council UK [G0301067]
- University College London Hospital NHS Trust
- Wellcome Trust
- National Society for Epilepsy
- Department of Health's NIHR Biomedical Research Centre
- Wellcome Department for Cognitive Neuroscience
- Brain
- Institute of Neurology, UCL, UK
- UCB
- Eisai Inc.
- Janssen
- Medical Research Council UK
- NIH
- BIAL
- Medical Research Council
- Action Medical Research
- Brain Research Trust
- Higher Education Funding Council
- GlaxoSmithKline
- Grunenthal GmbH
- EU
- Pfizer Inc
- Desitin Pharmaceuticals, GmbH
- MRC
- Wellcome Trust Foundation
- MRC [G0301067] Funding Source: UKRI
- Medical Research Council [G0200216, G0301067] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0509-10161] Funding Source: researchfish
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Objectives: Experiments in animal models have identified specific subcortical anatomic circuits, which are critically involved in the pathogenesis and control of seizure activity. However, whether such anatomic substrates also exist in human epilepsy is not known. Methods: We studied 2 separate groups of patients with focal epilepsies arising from any cortical location using either simultaneous EEG-fMRI (n = 19 patients) or [C-11]flumazenil PET (n = 18). Results: Time-locked with the interictal epileptiform discharges, we found significant hemodynamic increases common to all patients near the frontal piriform cortex ipsilateral to the presumed cortical focus. GABA(A) receptor binding in the same area was reduced in patients with more frequent seizures. Conclusions: Our findings of cerebral blood flow and GABAergic changes, irrespective of where interictal or ictal activity occurs in the cortex, suggest that this area of the human primary olfactory cortex may be an attractive new target for epilepsy therapy, including neurosurgery, electrical stimulation, and focal drug delivery. Neurology (R) 2011;77:904-910
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