| Project/Area Number |
16591431
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Cerebral neurosurgery
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| Research Institution | The University of Tokyo |
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Principal Investigator |
KAWAI Kensuke The University of Tokyo, Faculty of Medicine, Assistant Professor, 医学部附属病院, 講師 (70260924)
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| Co-Investigator(Kenkyū-buntansha) |
KAMADA Kyousuke The University of Tokyo, Faculty of Medicine, Specialized Assistant Professor, 医学部附属病院, 特任講師 (80372374)
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| Project Period (FY) |
2004 – 2006
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| Project Status |
Completed (Fiscal Year 2006)
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| Budget Amount *help |
¥3,500,000 (Direct Cost: ¥3,500,000)
Fiscal Year 2006: ¥600,000 (Direct Cost: ¥600,000)
Fiscal Year 2005: ¥700,000 (Direct Cost: ¥700,000)
Fiscal Year 2004: ¥2,200,000 (Direct Cost: ¥2,200,000)
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| Keywords | refractory epilepsy / temporal lobe epilepsy / intraoperative electrocorticography / hippocampus / function-preserving surgery |
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| Research Abstract |
The objectives of this project are (1) to elucidate the underlying mechanisms of generation of epileptiform discharges by evaluating the changes in intraoperative electrocorticography after various partial resection and disconnection of the medial temporal structures, and (2) to determine the minimal resection or disconnection necessary to inhibit the medial temporal epileptogenecity toward development of a less invasive and function-preserving surgical treatment. The major findings are as follows.
1. The spikes recording from the hippocampal surface are dominantly positive ones since alignment of the pyramidal neuron is reversed. Negative spikes are observed as well which are speculatively originated from the subicular and dentate neurons. Both synchronized and independent discharges are observed from the hippocampal surface and parahippocampal gyrus. The synchronized discharges are with or without latency. It is speculated that the former synchronization is via a transsynaptic propaga
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tion and the latter one is due to volume conduction effect. Disconnection of the temporal stem does not affect the spike frequency of the basal temporal areas. While lateral disconnection of the hippocampus abolishes the synchronized discharges from the hippocampus and basal temporal cortices, each structure continue to generate independent spikes, suggesting that each structure maintains its epileptogenecity. Hippocampal transactions perpendicular to the long axis preserving the fimbria-fornix abolishe the hippocampal spikes, but when the transaction is incomplete in a mediolateral direction the hippocampal spikes persists.
2. The novel function-preserving procedure using multiple hippocampal transaction achieved promising results both in seizure outcome and cognitive results. Seizure outcome was almost equal to the one of resective surgery although longer follow-up is required. Verbal memory recovered to the presurgical level before 6 months from transient deterioration shortly after dominant-sided surgery. Regional glucose utilization of the operated mediobasal temporal area remained low even when memory scores recovered. Further studies are required to elucidate the underlying mechanisms of the functional recovery. Less
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