Adam C
Unité d'Epileptologie, Hôpital de La Pitié-Salpêtrière, Paris.
Rev Neurol (Paris). 2006 Sep;162(8-9):813-8. doi: 10.1016/s0035-3787(06)75083-4.
Spatial and temporal patterns of the spread of partial epileptic seizures depend on the site from which they originate. Characterising seizure propagation patterns may help to better define the seizure focus. In medial temporal lobe epilepsies, seizure propagation to the contralateral temporal lobe is especially studied.
Intracranial EEG records permit more precise definition of patterns of contralateral propagation in medial temporal lobe epilepsies. Several pathways have been implicated, sometimes differently in distinct studies, in propagation to the contralateral temporal lobe: the three commissures (the corpus callosum, the ventral hippocampal commissure and the anterior commissure, which link the temporal lobes) and an indirect circuit via the frontal lobes. Delays measured for contralateral propagation of a seizure of temporo-limbic origin vary significantly around a mean value of about 30 seconds. This slow spread may depend in part on the relatively small size of human commissural projections from the amygdalo-hippocampal formation, which largely originate in the presubiculum. However, a larger commissural projection pathway originates in the paralimbic medial temporal lobe and electrical stimulation of the anterior perirhinal cortex can induce contralateral epileptic discharges with delays as short as 100 ms (Adam et al., 2004). Thus, seizure activity emerging from anterior paralimbic regions can propagate rapidly to the contralateral medial temporal lobe via the anterior commissure.
While the propagation of medial temporal lobe seizures is still debated, further studies are merited since the extent and speed of spread governs the electro-clinical semiology of seizures and our ability to identify their initiation site.
We review anatomical (Demeter et al., 1990) and neurophysiological (Wilson et al., 1990) data for a dual inter-temporal propagation of medial temporal lobe seizures at different speeds and via different pathways.
部分癫痫发作的传播时空模式取决于其起源部位。表征癫痫发作传播模式可能有助于更好地确定癫痫病灶。在内侧颞叶癫痫中，尤其对癫痫发作向对侧颞叶的传播进行了研究。
颅内脑电图记录能够更精确地定义内侧颞叶癫痫中对侧传播的模式。在向对侧颞叶的传播中，涉及到几条通路，不同研究中的情况有时有所不同：三条连合纤维（胼胝体、腹侧海马连合纤维和连接颞叶的前连合纤维）以及一条经额叶的间接通路。颞叶边缘起源的癫痫发作向对侧传播的延迟时间，在约30秒的平均值周围有显著差异。这种缓慢传播可能部分取决于杏仁核 - 海马结构的人类连合纤维投射相对较小，这些投射大多起源于前下托。然而，一条更大的连合纤维投射通路起源于边缘旁内侧颞叶，对前梨状皮质进行电刺激可诱发延迟短至100毫秒的对侧癫痫放电（亚当等人，2004年）。因此，起源于边缘旁前区的癫痫活动可通过前连合纤维迅速传播至对侧内侧颞叶。
虽然内侧颞叶癫痫发作的传播仍存在争议，但鉴于传播的范围和速度决定了癫痫发作的电 -临床症状学以及我们识别其起始部位的能力，进一步的研究是有必要的。
我们回顾了解剖学（德梅特等人，1990年）和神经生理学（威尔逊等人，1990年）数据，以探讨内侧颞叶癫痫发作以不同速度和通过不同通路进行的双颞叶间传播。
