Chayasirisobhon Sirichai
Regional Epilepsy Center, Kaiser Permanente Medical Center, Anaheim, California 92807, USA.
Acta Neurol Taiwan. 2009 Sep;18(3):155-60.
The mechanisms underlying the refractory temporal lobe epilepsy (TLE) are not well understood. Several explanations for refractory TLE are (1) an overexpression of P-glycoprotein (P-gp) encoded by multiple drug resistance 1 (MDR1) gene and other efflux transporters such as multidrug resistance protein (MRP) in the cerebrovascular endothelium in or around the region of the epileptic focus may lead to drug resistance in epilepsy; (2) the loss of antiepileptic drug sensitivity at certain target sites in the brain, including the sodium ion channel and the gamma aminobutyric acid (GABA)A receptor; and (3) seizures beget seizures by means of a cascade of events that include various types of neuronal damage, sprouting of neuronal axons and new synapse formations that establish aberrant glutamatergic synapses. TLE may be a progressive neurological disorder that requires early and effective treatment. Early recognition of refractory TLE and referral for epilepsy surgery may prevent years of unnecessary seizure activity and its consequences.
难治性颞叶癫痫（TLE）的潜在机制尚未完全明确。关于难治性TLE的几种解释如下：（1）多药耐药1（MDR1）基因编码的P-糖蛋白（P-gp）以及其他外排转运体，如多药耐药蛋白（MRP），在癫痫病灶区域内或周围的脑血管内皮细胞中过度表达，可能导致癫痫耐药；（2）大脑某些靶点部位抗癫痫药物敏感性丧失，包括钠离子通道和γ-氨基丁酸（GABA）A受体；（3）癫痫发作通过一系列事件引发更多发作，这些事件包括各种类型的神经元损伤、神经元轴突发芽以及新突触形成，进而建立异常的谷氨酸能突触。TLE可能是一种进行性神经疾病，需要早期有效治疗。早期识别难治性TLE并转诊至癫痫外科治疗，可能避免多年不必要的癫痫发作及其后果。
