Mesial temporal lobe epilepsy: What have we learned?
Mesial temporal lobe epilepsy: What have we learned?
复制标题
DOI：
10.1177/107385840100700410
复制
发表时间：
2001-08-01
期刊：
影响因子：
5.6
通讯作者：
Engel, J
中科院分区：
文献类型：
--
作者：
Engel, J
内侧颞袍癫痫是人类癫痫最常见的形式，其病理生理学基础通常是海马硬化，这是癫痫患者最常见的致癫痫病变。与内侧颞叶癫痫相关的致残性癫痫发作通常对抗癫痫药物有抵抗力，但大多数患者可以通过手术治疗消除。因此，前中颞叶切除术是治疗癫痫最常见的外科手术，一些患者需要立体定向植入脑内电极来定位致癫痫区域。这种临床环境为大量患者提供了微电极和微透析技术的侵入性体内研究以及单个癫痫手术切除后的体外研究。 紊乱。因此，现在人们对内侧颞叶癫痫中人类海马致癫痫特性的基本神经机制已经了解很多。对这种疾病的患者和动物模型进行的平行反复研究表明，除了兴奋增强之外，抑制增强也是导致自发性癫痫发作的超同步神经元放电出现的基础。最近的研究阐明了致痫性的独特电生理标志物，这可能具有有价值的诊断用途。尽管对内侧颞叶癫痫的基础研究可能最终提出新的治疗和预防方法，但还必须注意最大限度地应用现有的有效治疗方法。特别是，近年来手术治疗的安全性和有效性已大大提高，但这种替代疗法在全球范围内仍然严重未得到充分利用。适当增加将这种可通过手术治愈的综合征患者转诊至癫痫中心的人数，不仅可以缓解大量患者的致残性癫痫发作并减轻癫痫的负担，而且还可以为侵入性研究提供更多机会，最终可能带来更有效的治疗或治愈方法。
Mesial temporal robe epilepsy is the most common form of human epilepsy, and its pathophysiological substrate is usually hippocampal sclerosis, the most common epileptogenic lesion encountered in patients with epilepsy. The disabling seizures associated with mesial temporal lobe epilepsy are typically resistant to antiepileptic drugs but can be abolished in most patients by surgical treatment. Anteromesial temporal resection, therefore, is the most common surgical procedure performed to treat epilepsy, and stereotactically implanted intracerebral electrodes are required in some patients to localize the epileptogenic region, This clinical setting provides a large number of patients for invasive in vivo research with microelectrode and microdialysis techniques and in vitro research following surgical resection on a single epileptic disorder. Consequently, much has now been learned about the fundamental neuronal mechanisms underlying the epileptogenic properties of the human hippocampus in mesial temporal lobe epilepsy. Parallel reiterative studies in patients and animal models of this disorder indicate that enhanced inhibition, in addition to enhanced excitation, underlies the appearance of hypersynchronous neuronal discharges responsible for generating spontaneous seizures. Recent studies have elucidated what may be unique electrophysiological markers of epileptogenicity, which could have valuable diagnostic utility. Although basic research on mesial temporal lobe epilepsy may ultimately suggest novel approaches to treatment and prevention, attention must also be given to maximizing the application of available effective treatments. In particular, the safety and efficacy of surgical therapy has greatly improved in recent years, yet this alternative treatment remains seriously underutilized worldwide. An appropriate increase in referral of patients with this surgically remediable syndrome to epilepsy centers will not only relieve a great many patients of their disabling seizures and reduce the burden of epilepsy but will also provide increased opportunities for invasive research that could ultimately result in even more effective therapies or cures.