AANS Neurosurgeon | Volume 27, Number 4, 2018


Lack of Oxygen, Not Excessive Stimulation, Cause for Half of Seizure-related Brain Damage in Epilepsy

Neuronal degeneration is the most severe long-term consequence of repetitive seizures in patients with epilepsy, which until now was thought to be primarily caused by excitotoxicity, or over-stimulation of the neurons. New findings indicate hypoxia, or lack of oxygen, due to abnormal blood flow may be to blame for as much as half the neuronal death caused by the condition. A new study describes researchers’ investigation into the true culprit for seizure-related neuronal degeneration in epilepsy. Professors Stephen Macknik, PhD, and Susana Martinez-Conde, PhD, of SUNY Downstate Medical Center were co-authors in the study. Advanced imaging enabled researchers to detect a cascade of abnormal capillary vasodynamics which indicate that even though blood can be observed flowing into the hippocampus — a part of the brain that suffers damage from seizures — an unusually high number of microscopic vascular spasms block flow to some of the delicate brain tissue. This cumulative damage over a lifetime of seizures could contribute to severe cognitive decline or even death in patients with epilepsy. The study also discovered that microscopic spasms in capillaries occur, albeit with lower frequency, during normal brain function, too, suggesting that one problem caused by epilepsy is that seizures drive these vasospasms to abnormal levels.

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