Bartolomeil Fabrice, Guye Maxime, Wendling Fabrice, Gavaret Martine, Régis Jean, Chauvel Patrick
Service de Neurophysiologie Clinique, INSERM EMI U 99-26 Hôspital de la Timone, Marseille, France.
Epileptic Disord. 2002 Dec;4(4):235-41.
Seizure-related, abnormal affective and gestural behavior may involve some of the same processes as those underlying non-pathological behavior, but their mechanisms remain largely unknown. In this report, we studied a patient in whom seizures initially involved the medial temporal region before involving the frontal cortex. Seizure semiology of the second part of the seizure included marked emotional disturbances (dominated by intense fear and anger) and compulsive behavior to bite into something. This patient underwent presurgical evaluation including intracerebral electroencephalographic recordings (SEEG, stereoelectroencephalography).
In addition to SEEG examination, we used coherence analysis of signals as a means of studying functional coupling between different regions of the brain. Two seizures were studied. Coherence values from different periods of interest were compared to identify the neural structures involved at the onset of seizure activity as well as during the emotional behavioral changes.
A first network of neural structures was identified within the right anterior temporal regions (amygdala, temporal pole, hippocampus, temporal neocortex). At the time of intense affective and compulsive changes, and by comparison with the first ictal period, a second network was identified characterized by significant functional coupling between the amygdala, the orbito-frontal structures and the frontal opercular region, while a decrease in functional coupling between these regions and the dorsolateral region and the cingulate gyrus was apparent.
This study show that the emergence of an intense affective and behavioral state during a temporal lobe seizure could be related to the involvement of a network of structures including the anterior temporal lobe and the orbito-frontal cortex. The decrease of coupling between these regions and the lateral prefrontal and cingulate regions could also participate in these phenomena.
与癫痫发作相关的异常情感和手势行为可能涉及一些与非病理性行为相同的潜在过程，但其机制在很大程度上仍不清楚。在本报告中，我们研究了一名患者，其癫痫发作最初累及内侧颞叶，随后累及额叶皮质。癫痫发作第二部分的发作症状包括明显的情绪障碍（以强烈恐惧和愤怒为主）和强迫性咬东西行为。该患者接受了包括脑内脑电图记录（立体脑电图，SEEG）在内的术前评估。
除了SEEG检查外，我们还使用信号相干分析作为研究大脑不同区域之间功能耦合的一种手段。研究了两次癫痫发作。比较不同感兴趣时间段的相干值，以确定癫痫发作活动开始时以及情绪行为变化期间涉及的神经结构。
在右侧前颞叶区域（杏仁核、颞极、海马体、颞叶新皮质）内确定了第一个神经结构网络。在强烈情感和强迫性变化时，并与癫痫发作的第一个时期相比，确定了第二个网络，其特征是杏仁核、眶额结构和额眶区域之间存在显著的功能耦合，而这些区域与背外侧区域和扣带回之间的功能耦合明显减少。
本研究表明，颞叶癫痫发作期间强烈情感和行为状态的出现可能与包括前颞叶和眶额皮质在内的结构网络的参与有关。这些区域与外侧前额叶和扣带区域之间耦合的减少也可能参与了这些现象。
