Fenwick P B
Institute of Psychiatry, Maudsley Hospital, London, England.
Epilepsia. 1992;33 Suppl 6:S1-6.
The medical model of epilepsy suggests that seizures arise at random or in response to precise physiological events. Little weight is given to the part that ongoing brain activity may play in either precipitating or inhibiting seizures. In the focal epilepsies, the presence of damaged neurons that fire in the epileptic mode continuously and are called pacemaker cells has been demonstrated in both animal models and human epilepsy. If these pacemaker cells are firing all the time, why then do seizures arise only spasmodically? Behavior can be thought of as changes in the excitation and inhibition of populations of neurons. Therefore, it is likely that these excitatory and inhibitory waves will either increase or decrease the likelihood of seizures arising. The conditioning of the neurons to fire in volleys in a biofeedback paradigm, the conditioning of seizures in a classic Pavlovian sense, and the occurrence of seizures in response to behavioral changes has been shown in animal models of epilepsy and in humans. There is now evidence that children can both inhibit and generate their own seizures spontaneously. Many adult patients have behavioral strategies that they use either to inhibit or to stop the spreading seizures. In patients who have difficulties in coping with the stresses in their life, the voluntary generation of seizures may come to form a response to difficult situations. Thus, any complete epilepsy program must consider the patient, the behavior, and the relationship between seizures and behavior.
癫痫的医学模型表明，癫痫发作是随机出现的，或者是对精确生理事件的反应。人们很少关注持续的大脑活动在引发或抑制癫痫发作中可能起的作用。在局灶性癫痫中，在动物模型和人类癫痫中都已证实存在以癫痫模式持续放电的受损神经元，这些神经元被称为起搏细胞。如果这些起搏细胞一直在放电，那么为什么癫痫发作只是间歇性地出现呢？行为可以被看作是神经元群体兴奋和抑制的变化。因此，这些兴奋性和抑制性波很可能会增加或降低癫痫发作的可能性。在癫痫动物模型和人类中都已表明，在生物反馈范式中神经元以群集方式放电的条件作用、经典巴甫洛夫意义上癫痫发作的条件作用以及对行为变化做出反应时癫痫发作的发生。现在有证据表明，儿童能够自发地抑制和引发自己的癫痫发作。许多成年患者有他们用来抑制或阻止癫痫发作扩散的行为策略。在难以应对生活压力的患者中，自愿引发癫痫发作可能会成为对困难情况的一种反应。因此，任何完整的癫痫治疗方案都必须考虑患者、行为以及癫痫发作与行为之间的关系。
