Eggers Arnold E
Department of Neurology, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY 11203, United States.
Med Hypotheses. 2007;69(6):1284-9. doi: 10.1016/j.mehy.2007.03.025. Epub 2007 May 18.
Temporal lobe epilepsy (TLE) is the most common cause of intractable adult epilepsy. It is proposed that different kinds of epilepsy be classified into one of two categories, which correspond to the two basic kinds of neurons in the brain, that is, as diseases of oscillators or as diseases of resonators. Oscillator (or pacemacker) neurons are endowed with intrinsic conductances that permit periodic spontaneous generation of action potentials; in contrast, resonators are neurons which process information coming from sensory stimuli or from other neurons. A literature review supports the idea that TLE is a disease of faulty resonators. This means that seizures do not arise de novo in the seizure focus. The seizure focus responds to normal input with an abnormally large discharge that causes seizures. The most frequent trigger for TLE is psychological stress. A previously published theory of stress is reviewed. The stress circuit runs from the hippocampus to the amygdala to the dorsal raphe nucleus to the entorhinal cortex and back to the hippocampus. Cell loss in the dentate is central to the pathophysiology of both chronic stress and TLE, which establish a "vicious circle" relationship with one another. Once it is grasped that TLE is a disease of resonators and that all seizures in TLE are triggered, then it makes sense to address the major recognized trigger, which is stress. New therapeutic ideas for decreasing seizure frequency in TLE include the use of anti-depressants, ethosuximide (which blocks firing in the dorsal raphe nucleus), and mood-stabilizers (which block firing in the entorhinal cortex). The latter category includes several recognized anti-epileptic drugs. Drugs from all three categories should be used simultaneously and on an empirical basis in each patient.
颞叶癫痫（TLE）是成人顽固性癫痫最常见的病因。有人提出，不同类型的癫痫可分为两类，这两类分别对应于大脑中的两种基本神经元，即作为振荡器疾病或作为谐振器疾病。振荡器（或起搏器）神经元具有内在电导，可允许周期性自发产生动作电位；相比之下，谐振器是处理来自感觉刺激或其他神经元信息的神经元。文献综述支持TLE是一种谐振器故障疾病的观点。这意味着癫痫发作并非在癫痫病灶中从头产生。癫痫病灶对正常输入的反应是异常大量放电，从而导致癫痫发作。TLE最常见的触发因素是心理压力。本文回顾了先前发表的压力理论。压力回路从海马体延伸至杏仁核，再到中缝背核，再到内嗅皮质，最后回到海马体。齿状回中的细胞丢失是慢性压力和TLE病理生理学的核心，二者相互建立了“恶性循环”关系。一旦认识到TLE是一种谐振器疾病，且TLE中的所有癫痫发作都是由触发因素引起的，那么解决主要的公认触发因素——压力，就变得有意义了。降低TLE癫痫发作频率的新治疗思路包括使用抗抑郁药、乙琥胺（可阻断中缝背核的放电）和情绪稳定剂（可阻断内嗅皮质的放电）。后一类包括几种公认的抗癫痫药物。这三类药物应在每位患者身上同时并根据经验使用。
