University of Chicago
The aim of this pilot study is to understand hippocampal network function in mesial temporal lobe epilepsy (MTLE) and to test whether transcranial magnetic stimulation (TMS) targeting the network of the hippocampus can change hippocampal-dependent memory task performance and epileptic activity in people with (MTLE). Positive findings would implicate the hippocampal network as a source of these typical primary MTLE symptoms. Subjects with a primary diagnosis of MTLE will be enrolled in a non-randomized, non-blinded pilot experiment to test target engagement and preliminary efficacy of a novel neurostimulation approach targeting the hippocampal network. At baseline, subjects will undergo neurocognitive testing for hippocampal-dependent memory and functional magnetic resonance imagining (fMRI) neuroimaging assessment of brain structure and task-dependent activity. They will also receive scalp-electroencephalography (EEG) to measure interictal epileptiform discharge (IED) frequency at baseline, and will complete a seizure diary for one month. They will then receive high-frequency repetitive TMS targeting an area of parieto-occipital cortex defined based on fMRI connectivity with the hippocampus measured at baseline. The baseline assessments will then be repeated, using an alternate form of the memory test. The investigators will analyze changes from baseline in memory task performance, fMRI activity of the hippocampal network, IED frequency, and reported seizure frequency.
The purpose of this pilot study is to investigate hippocampal network dysfunction associated with mesial temporal lobe epilepsy (MTLE) and to examine whether network-targeted transcranial magnetic stimulation (TMS) can affect hippocampal connectivity, cognitive performance, and epileptic activity observed in adult subjects with MTLE. Subjects will be recruited through the University of Chicago Medicine Comprehensive Epilepsy Center and other local epilepsy centers. Subjects will complete up to 8 experimental sessions (1 baseline experiment/assessment, up to 5 TMS sessions, up to 2 post-treatm…
Inclusion Criteria: * Diagnosis of (pharmacoresistant) MTLE * Age 18+ years old * Native English speakers * Normal or corrected-to-normal near and far vision * Stable antiepileptic drugs (AED) regimen (unchanged for at least 1 month) Exclusion criteria: * Diagnosis of neurological illness other than MTLE * Taking drugs that impair cognition other than anticonvulsive medication for the treatment of MTLE (e.g., antipsychotics or psychostimulants). * Children under the age of 18 years
Subjects will receive high-frequency repetitive TMS to a parieto-occipital location defined in each subject based on high resting-state fMRI connectivity with the hippocampus at baseline