Post-Ictal Gamma Oscillations Predict Hippocampal Structural Integrity in Mesial Temporal Lobe Epilepsy

The underlying histopathology and epileptic network of patients with mesial temporal lobe epilepsy (mTLE) are difficult to ascertain. Here, we report a novel electrical activity following seizure termination, termed post-ictal gamma oscillations (PIGOs), recorded in mice with intrahippocampal kainic acid injection and a patient with mTLE. PIGOs are characterized by a spectral shift of increased power in gamma frequencies relative to decreased power in other frequencies, generating a gamma peak. PIGOs are accompanied by increased intracellular calcium levels among parvalbumin-positive interneurons and a direct current shift. Only a subgroup of animals in the study had PIGOs. These animals had less pronounced hippocampal sclerosis (HS) than those without PIGOs. To illustrate the translational potential of these findings, we analyzed data from two patients with unilateral mTLE, one with PIGOs and the other without. The patient with PIGOs had symmetrical hippocampi on neuroimaging, whereas the other exhibited overly decreased interictal glucose uptake in left hippocampus, suggesting left-sided HS. After receiving laser ablation of mesial temporal regions, the patient with PIGOs became seizure-free, whereas the other did not. Our results suggest that PIGOs may serve as a biomarker for a milder form of HS in patients with mTLE and for predicting treatment outcomes.