Epilepsy and the consciousness system: transient vegetative state?
Epilepsy and the consciousness system: transient vegetative state?
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DOI：
10.1016/j.ncl.2011.07.014
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发表时间：
2011-11
影响因子：
2.4
通讯作者：
Blumenfeld, Hal
中科院分区：
文献类型：
--
作者：
Blumenfeld, Hal
关键词：
意识是人类生活的基本核心特征，因此意识障碍产生重大影响并不奇怪。最近的研究表明，癫痫与其他意识障碍有许多共同特征。当患者在癫痫发作期间失去意识时，他们对外部刺激没有表现出有意义的反应;然而，眼睛通常是睁开的。此外，虽然没有足够的时间来确定是否存在睡眠-觉醒周期，但患者可能会表现出定向反应或其他简单的行为。因此，癫痫发作期间的意识受损类似于其他意识障碍，如植物人状态或最低意识状态，而昏迷则更少。与其他意识障碍的主要区别在于（癫痫持续状态除外）癫痫发作通常持续数分钟而不是数天，数月或数年。癫痫发作的短暂性质为确定意识受损及其恢复的解剖学和生理学基础提供了独特的机会。癫痫发作和其他意识障碍集中在一组共同的皮质和皮质下结构上。这些结构构成了“意识系统”，下一节将其定义为双侧内侧和外侧额顶联合皮层和皮层下唤醒系统。最近的神经影像学，颅内脑电图，和动物模型表明，意识系统形成了一个共同的解剖基板的所有癫痫发作类型造成意识障碍。引起短暂性意识障碍的癫痫发作的主要类型包括失神发作、全身强直阵挛发作和颞叶复杂部分性发作。本文将讨论的临床和行为特征，以及最近的神经影像学和电生理学研究，已开始阐明这些癫痫发作类型的意识障碍的病理生理学。意识障碍对癫痫患者生活质量的影响，以及潜在的治疗策略也将被讨论。
Consciousness is an essential core feature of human life, so it is not surprising that disorders of consciousness have a major impact. Recent work has demonstrated that epilepsy shares many features with other disorders of consciousness. When patients lose consciousness during epileptic seizures they exhibit no meaningful responses to external stimuli; however, the eyes are usually open. In addition, although there is insufficient time to determine whether sleep-wake cycles are present, patients may exhibit orienting responses or other simple behaviors. Therefore, impaired consciousness during seizures resembles other disorders of consciousness such as vegetative state or minimally conscious state and, less so, coma. The major difference from these other disorders of consciousness is that (with the exception of status epilepticus) seizures typically last for minutes rather than days, months, or years. The transient nature of epileptic seizures provides a unique opportunity for determining the anatomic and physiologic basis of impaired consciousness and its recovery.Seizures and other disorders of consciousness converge on a common set of cortical and subcortical structures. These structures constitute the “consciousness system,” defined in the next section as the bilateral medial and lateral fronto-parietal association cortex and subcortical arousal systems. Recent neuroimaging, intracranial EEG, and animal models demonstrate that the consciousness system forms a common anatomical substrate for all seizure types causing impaired consciousness. The main types of seizures causing transiently impaired consciousness include absence seizures, generalized tonic-clonic seizures, and temporal lobe complex partial seizures. This article will discuss the clinical and behavioral features, as well as recent neuroimaging and electrophysiology studies which have begun to shed light on the pathophysiology of impaired consciousness in these seizure types. The impact of impaired consciousness on quality of life in patients with epilepsy, and potential treatment strategies will also be discussed.
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影响因子：
5.6
作者：
Blumenfeld, H
通讯作者：
Blumenfeld, H
影响因子：
5.7
作者：
Archer, JS;Abbott, DF;Jackson, GD
通讯作者：
Jackson, GD
影响因子：
11
作者：
Bell, WL;Walczak, TS;Radtke, RA
通讯作者：
Radtke, RA
DOI：
10.1016/b978-0-12-374168-4.00002-2
发表时间：
2009-01-01
期刊：
NEUROLOGY OF CONSCIOUSNESS: COGNITIVE NEUROSCIENCE AND NEUROPATHOLOGY
影响因子：
--
作者：
Blumenfeld, Hal
通讯作者：
Blumenfeld, Hal
DOI：
10.1523/jneurosci.5101-09.2010
发表时间：
2010-04-28
期刊：
The Journal of neuroscience : the official journal of the Society for Neuroscience
影响因子：
--
作者：
Bai X;Vestal M;Berman R;Negishi M;Spann M;Vega C;Desalvo M;Novotny EJ;Constable RT;Blumenfeld H
通讯作者：
Blumenfeld H