Altered neural synchronization to pure tone stimulation in patients with mesial temporal lobe epilepsy: An MEG study

OBJECTIVE

Our previous study of monaural auditory evoked magnetic fields (AEFs) demonstrated that hippocampal sclerosis significantly modulated auditory processing in patients with mesial temporal lobe epilepsy (mTLE). However, the small sample size (n = 17) and focus on the M100 response were insufficient to elucidate the lateralization of the epileptic focus. Therefore, we increased the number of patients with mTLE (n = 39) to examine whether neural synchronization induced by monaural pure tone stimulation provides useful diagnostic information about epileptic foci in patients with unilateral mTLE.

METHODS

Twenty-five patients with left mTLE, 14 patients with right mTLE, and 32 healthy controls (HCs) were recruited. Auditory stimuli of 500-Hz tone burst were monaurally presented to subjects. The AEF data were analyzed with source estimation of M100 responses in bilateral auditory cortices (ACs). Neural synchronization within ACs and between ACs was evaluated with phase-locking factor (PLF) and phase-locking value (PLV), respectively. Linear discriminant analysis was performed for diagnosis and lateralization of epileptic focus.

RESULTS

The M100 amplitude revealed that patients with right mTLE exhibited smaller M100 amplitude than patients with left mTLE and HCs. Interestingly, PLF was able to differentiate the groups with mTLE, with decreased PLFs in the alpha band observed in patients with right mTLE compared with those (PLFs) in patients with left mTLE. Right hemispheric predominance was confirmed in both HCs and patients with left mTLE while patients with right mTLE showed a lack of right hemispheric predominance. Functional connectivity between bilateral ACs (PLV) was reduced in both patients with right and left mTLE compared with that of HCs. The accuracy of diagnosis and lateralization was 80%-90%.

CONCLUSION

Auditory cortex subnormal function was more pronounced in patients with right mTLE compared with that in patients with left mTLE as well as HCs. Monaural AEFs can be used to reveal the pathophysiology of mTLE. Overall, our results indicate that altered neural synchronization may provide useful information about possible functional deterioration in patients with unilateral mTLE.

Prepulse inhibition of change-related P50m no correlation with P50m gating

Both prepulse inhibition (PPI) of the startle response and P50 sensory gating are important tools to investigate the inhibitory mechanisms of sensory processing. However, previous studies found no or a weak association between these two measures, which may have been due to the different indexes used. We examined the relationship between P50 sensory gating and P50 PPI. P50m sensory gating and PPI of Change-related P50m were assessed in 14 subjects using magnetoencephalography. Concerning P50m sensory gating, the amplitudes of the response to the second click relative to that to the first one were reduced by 43 and 47% for the left and right hemisphere, respectively. Change-related P50m was evoked by an abrupt sound pressure increase by 10 dB in a continuous click train of 70 dB. When this test stimulus was preceded by a click (prepulse) with a weaker sound pressure increase (5 dB) at a prepulse-test interval of 30, 60, or 90 ms, Change-P50m was suppressed by 33 ~ 65% while the prepulse itself elicited no or very weak P50m responses. Although the amplitude of the P50m response to the first click and the amplitude of the Change-P50m test alone response were positively correlated (r = 0.6), the degree of the inhibition of the two measures was not (r = -0.06 ~ 0.14). The neural origin was estimated to be located in the supratemporal plane around the superior temporal gyrus or Heschl’s gyrus and did not differ between P50m and Change-P50m. The present results suggest that P50m and Change-P50m are generated by a similar group of neurons in the auditory cortex, while the mechanisms of P50m sensory gating and Change-P50m PPI are different.