Sugahara Hideyo
Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan.
Med Hypotheses. 2004;62(5):766-9. doi: 10.1016/j.mehy.2003.11.029.
The common physiological rationale for migraine, anger, and epileptic attacks is discussed. The potential importance of homeostatic reactions in brain blood perfusion is described. The author speculates that these attacks are induced to meet some urgent biological needs. Each attack of migraine, anger, and epilepsy results in increased regional cerebral blood flow, with hypoperfusion being shown in inter-icteric states. This hypoperfusion may also be related to cerebral ischemic disease, organic change, some critical condition, or vasoconstriction due to sympathetic hyperactivity. Migraine attack is a subacute local vasomotor response. In contrast, anger and epileptic attacks are different manifestations of acute solemn general neuropsychiatric vasomotor reflexes. The newer paradigm of the etiological integration of these three kinds of attacks based on cerebral hemodynamic change does not only explain the mechanism of seizure-producing treatments such as electroconvulsive therapy, but also indicates the significance of cerebral vasodilative demands for the particular treatment of migraine, aggressive behavior, and epileptic seizures.
本文讨论了偏头痛、愤怒和癫痫发作常见的生理原理。描述了脑血流灌注中稳态反应的潜在重要性。作者推测这些发作是为了满足某些紧急的生物学需求而诱发的。偏头痛、愤怒和癫痫的每次发作都会导致局部脑血流增加，发作间期则表现为灌注不足。这种灌注不足也可能与脑缺血性疾病、器质性改变、某些危急情况或交感神经过度活跃引起的血管收缩有关。偏头痛发作是一种亚急性局部血管运动反应。相比之下，愤怒和癫痫发作是急性严重全身性神经精神血管运动反射的不同表现。基于脑血流动力学变化的这三种发作病因整合的新范式，不仅解释了诸如电休克治疗等癫痫发作治疗的机制，还指出了脑血管舒张需求对于偏头痛、攻击性行为和癫痫发作特殊治疗的意义。
