The Michael Trimble Neuropsychiatry Research Group, Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UK.
Epilepsy Behav. 2011 Dec;22(4):651-8. doi: 10.1016/j.yebeh.2011.10.003. Epub 2011 Nov 13.
The assessment of ictal consciousness has been the landmark criterion for the differentiation between simple and complex partial seizures over the last three decades. After review of the historical development of the concept of "complex partial seizure," the difficulties surrounding the simple versus complex dichotomy are addressed from theoretical, phenomenological, and neurophysiological standpoints. With respect to consciousness, careful analysis of ictal semiology shows that both the general level of vigilance and the specific contents of the conscious state can be selectively involved during partial seizures. Moreover, recent neuroimaging findings, coupled with classic electrophysiological studies, suggest that the neural substrate of ictal alterations of consciousness is twofold: focal hyperactivity in the limbic structures generates the complex psychic phenomena responsible for the altered contents of consciousness, and secondary disruption of the network involving the thalamus and the frontoparietal association cortices affects the level of awareness. These data, along with the localization information they provide, should be taken into account in the formulation of new criteria for the classification of seizures with focal onset.
在过去的三十年里，发作意识的评估一直是简单性和复杂性部分性癫痫发作之间区别的标志性标准。在回顾“复杂性部分性癫痫发作”概念的历史发展之后，从理论、现象学和神经生理学的角度探讨了单纯与复杂二分法的困难。就意识而言，对发作半侧状态的仔细分析表明，在部分性发作期间，警觉水平的一般水平和意识状态的具体内容都可以被选择性地参与。此外，最近的神经影像学发现，加上经典的电生理学研究，提示发作意识改变的神经基础是双重的：边缘结构的局灶性过度活动产生了负责意识内容改变的复杂心理现象，而丘脑和额顶联合皮质网络的继发性破坏则影响了意识水平。这些数据，以及它们提供的定位信息，应该在制定以局灶性发作为起始的癫痫发作的新分类标准时加以考虑。
