An alteration in excitatory and inhibitory influences may underlie epilepsy. We used bilateral intrahippocampal microdialysis to test the hypothesis that an increase in extracellular glutamate may trigger spontaneous seizures. The concentrations of glutamate and gamma-aminobutyric acid (GABA), the brain's major inhibitory neutrotransmitter, were measured in microdialysates before and during seizures in 6 patients with complex partial epilepsy investigated before surgery. Before seizures, concentrations of glutamate were higher in the epileptogenic hippocampus, whereas GABA concentrations were lower. During seizures, there was a sustained increase in extracellular glutamate to potentially neurotoxic concentrations in the epileptogenic hippocampus. Moreover, the increase preceded seizure. GABA concentrations were unchanged before seizures, but increased during them, with a greater rise in the non-epileptogenic hippocampus, suggesting that a rise in extracellular glutamate may precipitate seizures and that the concentrations reached may cause cell death.