A study of monoamine metabolism in human epilepsy.
Fourteen patients with intractable epilepsy underwent surgical resection of their epileptogenic focus. Hippocampal and temporal cortical samples were obtained, and subjected to high performance liquid chromatography with electrochemical detection. Levels of 5-hydroxyindoleacetic acid (5-HIAA) in actively spiking temporal cortex were 0.454 +/- 0.012 ng/mg (mean +/- SEM), contrasting with less actively spiking cortex values of 0.248 +/- 0.042 ng/mg and normal literature values, obtained from post-mortem material, of 0.140 +/- 0.050 ng/mg. Similarly, homovanillic acid (NVA) levels were significantly increased in epileptic tissue compared to normal literature values. Actively spiking cortex values were 0.172 +/- 0.001 pg/mg, less active cortex values were 0.058 +/- 0.012 pg/mg, and literature values were 0.011 +/- 0.002 pg/mg. Although a direct statistical comparison between the data reported here and literature values may not be valid, the findings show a continuum from normal through increasingly active electrode sites, likely reflecting a true biologic phenomena. Similarly, statistically significant increases in 5-HIAA and HVA levels were found in hippocampal tissue, which also showed significantly lower dihydroxyphenylacetic acid levels. We conclude that raised levels of serotonin and dopamine metabolites in actively spiking cortex likely reflect an increase in their turnover, and are an epileptic epiphenomenon. Exaggeration of turnover may represent the "metabolic noise" of epilepsy, rather than a concerted strategy of local or distal neurons to contain an epileptogenic focus.