Fenwick P
Maudsley Hospital, London, England.
Adv Neurol. 1991;55:163-83.
These behavioral studies provide abundant evidence of the close interrelation between seizure activity and behavior. They reaffirm the point already made several times in this chapter: Seizures do not occur in a behavioral vacuum. They also strengthen the theoretical framework which provides for behavioral treatment of patients with epilepsy. With the detailed knowledge that we now have of the epilepsy focus and the way that it is connected to the surrounding cerebral mechanisms, it really is not surprising that seizure control is significantly influenced by altering the outlook and behavior of the patient with epilepsy. Seizures should not be thought of as arising randomly. They occur, in the case of focal seizures, when the pools of group 2 neurons are sufficiently excited for seizure activity to spread. Generalized seizures occur when the level of cortical excitability or of corticoreticular excitation has reached a point at which thalamic recruiting volleys generalize and start to spread. In the case of the focal epilepsies, a detailed clinical history should be taken as to the nature and characteristics of the aura; the history should also include details regarding the form that the seizure generalization or spread may take. This information allows the accurate location of the seizure focus, as well as of the cerebral structures through which the seizure discharge passes. The position of the focus will determine the relationship between the individual and his epilepsy. It will define those aspects of the psychic life or behavior of a patient which will both trigger and inhibit seizure activity. Detailed discussion of this information with the patient will help him to understand that his seizures are not part of a random process but are, instead, intimately related to how he feels, what he is doing, and what he is thinking. A complete treatment of epilepsy is not just the administration of drugs; rather, it also includes (a) teaching the patient about his brain and its functioning and (b) how the patient's feelings, thinking, and behavior can all be used in the control of his epilepsy.
这些行为学研究提供了大量证据，证明癫痫发作活动与行为之间存在密切的相互关系。它们再次证实了本章已多次提及的观点：癫痫发作并非发生在行为真空中。它们还强化了为癫痫患者提供行为治疗的理论框架。鉴于我们现在对癫痫病灶以及它与周围脑机制的连接方式有了详细了解，通过改变癫痫患者的观念和行为能显著影响癫痫控制，这确实不足为奇。癫痫发作不应被视为随机产生。在局灶性癫痫发作时，当第2组神经元池被充分激发，癫痫活动得以扩散。全身性癫痫发作则是在皮质兴奋性水平或皮质网状兴奋性达到丘脑募集性放电能够泛化并开始扩散的程度时发生。对于局灶性癫痫，应详细记录先兆的性质和特征等临床病史；病史还应包括癫痫发作泛化或扩散可能采取的形式的详细信息。这些信息有助于准确确定癫痫病灶的位置，以及癫痫放电所经过的脑结构。病灶的位置将决定个体与癫痫之间的关系。它将界定患者心理生活或行为中那些既能触发又能抑制癫痫活动的方面。与患者详细讨论这些信息将有助于他明白，他的癫痫发作并非随机过程的一部分，而是与他的感受、所做之事以及所想之事密切相关。完整的癫痫治疗不仅仅是给药；相反，它还包括：（a）向患者传授关于其大脑及其功能的知识，以及（b）如何利用患者的感受、思维和行为来控制癫痫。
