title: Spreading photoparoxysmal EEG response is associated with an abnormal cortical excitability pattern.
abstract: Photosensitivity or photoparoxysmal response (PPR) is a highly heritable electroencephalographic trait characterized by an abnormal cortical response to intermittent photic stimulation (IPS). In PPR-positive individuals, IPS induces spikes, spike-waves or intermittent slow waves. The PPR may be restricted to posterior visual areas (i.e. local PPR with occipital spikes only) or spread to anterior non-visual cortical regions (i.e. PPR with propagation). The mechanisms underlying the PPR and causing its spread remain to be clarified. In unmedicated PPR-positive individuals and PPR-negative control participants without any history of previous seizures, we used focal transcranial magnetic stimulation (TMS) to investigate the excitability of the visual or primary motor cortex (M1). In the first experiment [18 healthy control subjects (i.e. without PPR in electroencephalography: 6 females, mean age 26.5 +/- 7.34 years) and 17 healthy participants with PPR (7 females, mean age 25.18 +/- 12.2 years) were studied], occipital TMS was used to elicit phosphenes or to suppress the visual perception of letter trigrams. PPR-positive individuals with propagation had lower phosphene thresholds and steeper stimulus-response curves than individuals without PPR or with occipital spikes only. Occipital TMS also induced a stronger suppression of visual perception in PPR-positive subjects with propagation relative to subjects without PPR or with occipital spikes. In the second experiment, we applied TMS over the right M1 without concurrent IPS and measured the motor threshold, the stimulus response curve, and the duration of the cortical silent period (CSP) in PPR positive individuals with propagation and in PPR-negative control participants [15 right-handed healthy subjects without PPR (3 males, mean age 17.7 +/- 3.6 years) and 14 right-handed healthy individuals showing a PPR with propagation (3 males, mean age 17.4 +/- 3.9 years)]. PPR-positive individuals showed no changes in these excitability measures relative to the PPR-negative control participants. We also measured the modifiability of the CSP by continuous IPS at a frequency of 18 or 50 Hz. While IPS reduced the duration of the CSP in PPR-negative control subjects, IPS had no effect on the duration of the CSP in PPR-positive individuals. Our results provide first time evidence that the propagation of the PPR is associated with increased excitability of the occipital but not the motor cortex. The stronger inhibitory effect of TMS on visual perception and the failure of IPS to shorten the CSP in PPR-positive participants may possibly reflect adaptive changes that prevent the provocation of seizures during the PPR.
authors.affiliation: Neuropediatric Department, Pediatric Hospital, Christian Albrechts University, Kiel, Germany. m.siniatchkin@pedneuro.uni-kiel.de
authors.forename: Michael
authors.initials: M
authors.lastname: Siniatchkin
authors.forename: Sergey
authors.initials: S
authors.lastname: Groppa
authors.forename: Bettina
authors.initials: B
authors.lastname: Jerosch
authors.forename: Hiltrud
authors.initials: H
authors.lastname: Muhle
authors.forename: Christoph
authors.initials: C
authors.lastname: Kurth
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Shepherd
authors.forename: Hartwig
authors.initials: H
authors.lastname: Siebner
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stephani
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000502:physiology*; D004569:Electroencephalography / Q000379:methods*; D019054:Evoked Potentials, Motor / Q000502:physiology; D005074:Evoked Potentials, Visual / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000502:physiology; D010719:Phosphenes / Q000502:physiology; D010775:Photic Stimulation / Q000009:adverse effects*; D012684:Sensory Thresholds; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D014793:Visual Cortex / Q000502:physiology; D014796:Visual Perception / Q000502:physiology