Posttraumatic epilepsy: The endophenotypes of a human model of epileptogenesis
Posttraumatic epilepsy: The endophenotypes of a human model of epileptogenesis
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DOI：
10.1111/j.1528-1167.2008.02006.x
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发表时间：
2009-01-01
期刊：
影响因子：
5.6
通讯作者：
Van Ness, Paul C.
中科院分区：
文献类型：
--
作者：
Diaz-Arrastia, Ramon;Agostini, Mark A.;Van Ness, Paul C.
创伤后癫痫是创伤性脑损伤（TBI）的常见并发症，发生在高达15-20%的严重脑外伤患者中。创伤约占社区慢性癫痫的5%。由于创伤后癫痫是一种常见的疾病，并且由于损伤和慢性癫痫发作之间的潜伏期相对较短，因此创伤后癫痫是测试抗癫痫治疗的良好模型。然而，几个良好的临床试验未能证明几种常见的抗惊厥药的抗癫痫疗效。创伤后癫痫可以通过多种机制发生，这些机制通常在单个患者中共存。穿透性脑损伤在皮质产生瘢痕，与约50%的创伤后癫痫风险相关，而非穿透性脑损伤可产生局灶性挫伤和颅内血肿，与高达30%的创伤后癫痫风险相关。此外，闭合性头部损伤通常会产生弥漫性震荡性损伤，轴突被剪断，易受损伤的大脑区域（如海马）会受到选择性损伤。这些替代机制的临床、神经生理学、影像学和神经病理学特征或致痫性不同。很可能需要更好地了解脑外伤引起的癫痫亚型，以成功地确定抗癫痫治疗。
Posttraumatic epilepsy is a common complication of traumatic brain injury (TBI), occurring in up to 15-20% of patients with severe brain trauma. Trauma accounts for approximately 5% of chronic epilepsy in the community. Because it is a common condition, and because of the relatively short latency period between injury and onset of chronic seizures, posttraumatic epilepsy represents a good model to test antiepileptogenic therapies. However, several well-conducted clinical trials have failed to demonstrate antiepileptogenic efficacy for several common anticonvulsants. Posttraumatic epilepsy can arise through a number of mechanisms, which often coexist within a single patient. Penetrating brain injury produces a cicatrix in the cortex and is associated with a risk of posttraumatic epilepsy of approximately 50%, whereas nonpenetrating head injury may produce focal contusions and intracranial hemorrhages, and is associated with a risk of posttraumatic epilepsy of up to 30%. Furthermore, closed head injury often produces diffuse concussive injury, with shearing of axons and selective damage to vulnerable brain regions, such as the hippocampus. The clinical, neurophysiologic, imaging, and neuropathologic features or epileptogenicity differ between these alternate mechanisms. It is likely that better understanding of the subtypes of epilepsy resulting from brain trauma will be required to successfully identify antiepileptogenic therapies.