Because oral pharmacological treatment of neocortical focal epilepsy is limited due to common systemic side effects and relatively low drug concentrations reached at the epileptic foci locally, application of antiepileptic agents directly onto the neocortical focus may enhance treatment tolerability and efficacy. We describe the effects of cortically applied sodium valproate (VPA) in two patients with pharmacoresistant neocortical focal epilepsy who were selected for epilepsy surgery after a circumscribed epileptic focus had been determined by invasive presurgical evaluation using subdural electrodes. Local VPA modified epileptic activity as electrocorticographically recorded from the chronic focus in both patients. In addition, VPA induced local increase of the inhibitory neurotransmitter γ‐aminobutyric acid (GABA) in cortical tissue samples, whereas the excitatory glutamate was possibly decreased. In this clinical pilot study, we could show antiepileptic effects of cortically applied VPA in humans by electrocorticographic and neurochemical parameters.

中文翻译：

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药物耐药局灶性癫痫患者局部皮质丙戊酸盐应用后皮质电图和神经化学结果

由于新皮质局灶性癫痫的口服药物治疗由于常见的全身副作用和在癫痫病灶局部达到的药物浓度相对较低而受到限制，因此将抗癫痫药直接应用于新皮质病灶可能会提高治疗的耐受性和疗效。我们描述了皮质应用丙戊酸钠 (VPA) 对两名耐药性新皮质局灶性癫痫患者的影响，这些患者在使用硬膜下电极通过侵入性术前评估确定了局限性癫痫病灶后被选择进行癫痫手术。局部 VPA 改变了癫痫活​​动，如皮层电图记录的两名患者的慢性病灶。此外，VPA 诱导皮质组织样本中抑制性神经递质γ-氨基丁酸（GABA）的局部增加，而兴奋性谷氨酸可能减少。在这项临床试验研究中，我们可以通过皮层电图和神经化学参数显示皮质应用 VPA 对人类的抗癫痫作用。