Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany.
Epilepsy Behav. 2011 Oct;22(2):231-9. doi: 10.1016/j.yebeh.2011.06.016. Epub 2011 Jul 23.
Electroencephalographic abnormalities in the absence of any other major laboratory or imaging findings are a frequently encountered phenomenon in many psychiatric disorders. In some cases, clear-cut interictal epileptiform EEG abnormalities in patients with classic primary psychiatric disorders lead to referrals to epilepsy departments for diagnostic evaluation. Although video/EEG telemetry in these cases generally proves that there is no direct temporal link between the EEG pathologies and psychiatric symptoms, and therefore the psychiatric syndrome cannot be regarded as epilepsy, the relevance of the EEG abnormalities remains open to discussion. In this article we put forward the model of a paraepileptic pathomechanism, which might explain the pathogenetic role of such EEG pathologies, at least in subgroups of such patients. We propose that ictal or nonictal epileptic neurophysiological activity can lead to local area neuronal network inhibition (LANI). In this model clinical symptoms are related not to the excitatory epileptiform abnormalities themselves, but to the extent, site, and dynamics of the resulting local neuronal network inhibition. The LANI hypothesis is capable of explaining the complex relationship between EEG abnormalities and clinical symptoms in different neuropsychiatric syndromes and can be verified and falsified in empirical research.
在许多精神疾病中，没有其他主要实验室或影像学发现的脑电图异常是一种经常遇到的现象。在某些情况下，伴有典型原发性精神障碍的患者存在明确的发作间期癫痫样脑电图异常，这导致他们被转介到癫痫科进行诊断评估。尽管这些情况下的视频/脑电图遥测通常证明脑电图病理与精神症状之间没有直接的时间关联，因此不能将精神综合征视为癫痫，但脑电图异常的相关性仍存在争议。在本文中，我们提出了一种拟癫痫发病机制模型，该模型至少可以解释此类患者亚群中此类脑电图病理的发病机制作用。我们提出，发作期或非发作期癫痫神经生理活动可导致局部神经网络抑制（LANI）。在该模型中，临床症状与兴奋性癫痫样异常本身无关，而是与由此产生的局部神经元网络抑制的程度、部位和动态有关。LANI 假说能够解释不同神经精神综合征中脑电图异常与临床症状之间的复杂关系，并能够通过实证研究进行验证和证伪。
