Mechanisms of intrinsic epileptogenesis in human gelastic seizures with hypothalamic hamartoma.

Mechanisms of intrinsic epileptogenesis in human gelastic seizures with hypothalamic hamartoma.
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DOI:
10.1111/cns.12348
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发表时间:
2015-02
影响因子:
5.5
通讯作者:
Kerrigan JF
Kerrigan JF
中科院分区:
医学1区
文献类型:
--
作者:
Wu J;Gao M;Shen JX;Qiu SF;Kerrigan JF

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人类下丘脑错构瘤(HH)是一种罕见的发育畸形,通常以痉挛性癫痫发作为特征,药物治疗难以治愈。 HH 的发作期脑电图记录表明,痉挛性癫痫发作的癫痫源位于 HH 病变本身。针对 HH 的手术技术的最新进展使癫痫发作控制得到了显着改善,这进一步支持了癫痫发作起源于 HH 的假设。然而,人们对这种皮质下病变中癫痫发生的基本细胞和分子机制知之甚少。自 2003 年以来,巴罗神经病学研究所一直维持着一个多学科临床项目来评估和治疗 HH 患者。该计划提供了一个独特的机会,利用手术切除的 HH 组织来研究癫痫发生的基本机制。第一份关于 HH 神经元电生理特性的报告于 2005 年发表。此后,正在进行的研究为 HH 产生癫痫活动的机制提供了更多见解。在这篇综述中,我们总结了这一进展,并提出了一个细胞模型,表明 GABA 介导的兴奋有助于 HH 病变中的癫痫发生。
Human hypothalamic hamartoma (HH) is a rare developmental malformation often characterized by gelastic seizures, which are refractory to medical therapy. Ictal EEG recordings from the HH have demonstrated that the epileptic source of gelastic seizures lies within the HH lesion itself. Recent advances in surgical techniques targeting HH have led to dramatic improvements in seizure control, which further supports the hypothesis that gelastic seizures originate within the HH. However, the basic cellular and molecular mechanisms of epileptogenesis in this subcortical lesion are poorly understood. Since 2003, Barrow Neurological Institute has maintained a multidisciplinary clinical program to evaluate and treat patients with HH. This program has provided a unique opportunity to investigate the basic mechanisms of epileptogenesis using surgically resected HH tissue. The first report on the electrophysiological properties of HH neurons was published in 2005. Since then, ongoing research has provided additional insights into the mechanisms by which HH generate seizure activity. In this review, we summarize this progress and propose a cellular model that suggests that GABA-mediated excitation contributes to epileptogenesis in HH lesions.
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