Temporal lobe epilepsy: where do the seizures really begin?
Temporal lobe epilepsy: where do the seizures really begin?
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DOI：
10.1016/j.yebeh.2008.09.017
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发表时间：
2009-01
影响因子：
2.6
通讯作者：
Bertram, Edward H.
中科院分区：
文献类型：
--
作者：
Bertram, Edward H.
准确定义癫痫发作的部位对于我们理解颞叶癫痫的病理生理以及手术治疗具有重要意义。内侧颞叶边缘区的切除导致癫痫控制率高，但癫痫控制不完全的患者数量相对较多，手术治愈率低，这表明病灶超出了通常的手术切除范围。对病理程度的重新评估以及来自动物模型的新数据表明，癫痫发作的焦点至少在某些情况下延伸到海马体和杏仁核之外，这些区域通常在手术时被切除。在这篇综述中，我们将研究目前的信息的病理和生理的内侧颞叶癫痫综合征，特别强调的变化和癫痫发作的模式的分布。然后，我们将提出一个假设，在这种疾病的癫痫发作的重点的性质，并讨论其临床意义，最终目标是改善手术结果和开发非手术治疗，可能会改善癫痫发作控制。
Defining precisely the site of seizure onset has important implication for our understanding of the pathophysiology of temporal lobe epilepsy as well as for the surgical treatment of the disorder. Removal of the limbic areas of the medial temporal lobe has led to a high rate of seizure control, but the relatively large number of patients for whom seizure control is incomplete as well as the low rate of surgical cure suggest that the focus extends beyond the usual limits of surgical resection. A reevaluation of the extent of the pathology as well as new data from animal models suggest that the seizure focus extends, at least in some cases, beyond the hippocampus and amygdala that are usually removed at the time of surgery. In this review we will examine current information about the pathology and physiology of the mesial temporal lobe epilepsy syndrome, with a special emphasis on the distribution of the changes and the patterns of seizure onset. We will then propose a hypothesis for the nature of the seizure focus in this disorder and discuss its clinical implications, with the ultimate goal of improving surgical outcomes and developing nonsurgical therapies that may improve seizure control.
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