All ETDs from UAB

Advisory Committee Chair

Jerzy P Szaflarski

Advisory Committee Members

Roy C Martin

Rajesh K Kana

Jane B Allendorfer

Burel R Goodin

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Recent advances in neurostimulation and neuromodulation techniques, such as transcranial magnetic stimulation (TMS), may offer alternative treatment options to patients with idiopathic generalized epilepsies (IGEs). In a previous study, we utilized TMS to demonstrate a relationship between increased cortical excitability (i.e. hyperexcitability), attentional dysfunction, and mood disturbance in a sample of healthy adults. In general, patients with IGEs are found to exhibit cortical hyperexcitability, cognitive dysfunction, and mood problems; however, a relationship between these variables in IGEs has not yet been investigated. Importantly, patients with treatment-resistant IGEs (trIGEs) are shown to demonstrate greater cortical excitability, cognitive deficits, and mood problems than patients with controlled IGEs (cIGEs). Overall, this dissertation aimed to investigate the influences of cortical excitability and seizure control on neuropsychological functioning in patients with IGEs. The following studies (1) provide an extensive review on the current uses of neurostimulation and neuromodulation devices in the treatment of epilepsy, (2) demonstrate the influences of both cortical excitability and seizure control on attention performance in patients with IGEs, and (3) show that cortical excitability affects mood state in patients with cIGEs and trIGEs. Our findings provide further support for the relationship between cortical excitability and neuropsychological functioning, and specifically demonstrate that cortical hyperexcitability is associated with poorer attentional ability and greater mood disturbance in patients with IGEs. They also suggest that GABAB dysfunction may play a role these relationships. Further investigation is needed to determine the causal nature of these relationships, and whether TMS or other neurostimulation/neuromodulation devices may be used to improve attention deficits or mood problems in IGEs, or other clinical populations with cortical hyperexcitability.

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