Bertram Edward H
Department of Neurology, University of Virginia, Charlottesville, VA 22908-0394, USA.
Epilepsy Behav. 2009 Jan;14 Suppl 1(Suppl 1):32-7. doi: 10.1016/j.yebeh.2008.09.017. Epub 2008 Oct 31.
Defining precisely the site of seizure onset has important implications for our understanding of the pathophysiology of temporal lobe epilepsy, as well as for the surgical treatment of the disorder. Removal of the limbic areas of the medial temporal lobe has led to a high rate of seizure control, but the relatively large number of patients for whom seizure control is incomplete, as well as the low rate of surgical cure, suggests that the focus extends beyond the usual limits of surgical resection. Reevaluation of the extent of the pathology, as well as new data from animal models, suggests that the seizure focus extends, at least in some cases, beyond the hippocampus and amygdala, which are usually removed at the time of surgery. In this review, we examine current information about the pathology and physiology of mesial temporal lobe epilepsy syndrome, with special emphasis on the distribution of the changes and patterns of seizure onset. We then propose a hypothesis for the nature of the seizure focus in this disorder and discuss its clinical implications, with the ultimate goal of improving surgical outcomes and developing nonsurgical therapies that may improve seizure control.
精确确定癫痫发作起始部位对于我们理解颞叶癫痫的病理生理学以及该疾病的外科治疗具有重要意义。切除内侧颞叶的边缘区域已使癫痫控制率很高，但仍有相对较多患者的癫痫控制不完全，且手术治愈率较低，这表明癫痫病灶超出了通常的手术切除范围。对病理范围的重新评估以及动物模型的新数据表明，至少在某些情况下，癫痫病灶超出了海马体和杏仁核，而这两个结构通常在手术时会被切除。在本综述中，我们研究了有关内侧颞叶癫痫综合征病理和生理学的当前信息，特别强调了变化的分布和癫痫发作起始模式。然后，我们针对该疾病中癫痫病灶的性质提出一个假设，并讨论其临床意义，最终目标是改善手术效果并开发可能改善癫痫控制的非手术疗法。
