Higher brain function: its physiology and pathology revealed by epilepsy research

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  • Matsumoto Riki
    Division of Neurology, Kobe University Graduate School of Medicine
  • Shimotake Akihiro
    Department of Neurology, Kyoto University Graduate School of Medicine
  • Yamao Yukihiro
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • Kikuchi Takayuki
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • Kunieda Takeharu
    Department of Neurosurgery, Ehime University Graduate School of Medicine
  • Ikeda Akio
    Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine

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  • てんかん病態から垣間見る高次脳機能とその変容

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Abstract

<p>It is the cortices and the cortico-cortical connections that are involved in manifestation of normal cortical functions as well as production of seizure symptoms. In other words, cortical function and seizure semiology are the two sides of the same coin. In this regard, both epileptic activities (seizures) and high frequency electrical stimulation (functional mapping) can produce positive or negative phenomena, depending on the site of activation (primary vs. non-primary cortices). We introduce the state-of-the art methods of clinical functional brain mapping in the presurgical evaluation for epilepsy surgery, and show how the combined methods can delineate functions and connectivity of the brain networks such as the fronto-parietal network. We also show how cognitive neurophysiology delineates the pathophysiology of reading epilepsy, a representative form of reflex epilepsy, by introducing our recent single case study that combined multimodal non-invasive techniques. Katakana reading initially induced epileptic activation of the left posterior basal temporal area, and eventually of the whole left fronto-temporal network. Given hyperexcitability in the left fronto-temporal network normally recruited for reading, prolonged reading could have resulted in epileptiform discharges and clinical seizures.</p>

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