Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Seizure. 2012 Apr;21(3):153-9. doi: 10.1016/j.seizure.2011.12.016. Epub 2012 Feb 1.
Approximately 30-50% of patients with brain tumors present with seizures as the initial symptom. Seizures play a very important role in the quality of life, particularly in patients with slow-growing primary brain tumors. Tumor-related seizures are often refractory to antiepileptic treatment. Despite the importance of this subject to the fields of neurology, neurosurgery and neurooncology, the pathogenesis of tumor-related epilepsy remains poorly understood. This review summarizes possible mechanisms underlying the pathogenesis of tumor-related epilepsy, including both tumoral and peri-tumoral aspects. Tumor cells themselves may create intrinsic epileptogenicity, and inadequate homeostasis in the peri-tumoral tissues may lead to seizure susceptibility. Other local changes in electrolytes, perfusion, metabolism, and enzymes could also contribute. It is generally accepted that changes in amino acid neurotransmission are the most important mechanism underlying tumor-related seizures, and changes in extracellular ions also play an important role. Hypoxia, acidosis, and metabolic, immunological, and inflammatory changes may also be involved in the occurrence of seizures. Knowledge of these mechanisms may provide guidance in the search for new strategies for the surgical and medical treatment of tumor-related epilepsy.
约 30-50%的脑瘤患者以癫痫发作为首发症状。癫痫在生活质量方面起着非常重要的作用，尤其是在生长缓慢的原发性脑瘤患者中。肿瘤相关性癫痫往往对抗癫痫治疗有抗性。尽管这一主题对神经病学、神经外科学和神经肿瘤学领域非常重要，但肿瘤相关性癫痫的发病机制仍知之甚少。本文综述了肿瘤相关性癫痫发病机制的可能机制，包括肿瘤内和肿瘤周围方面。肿瘤细胞本身可能产生内在的致痫性，肿瘤周围组织中稳态失调可能导致癫痫易感性。其他局部电解质、灌注、代谢和酶的变化也可能起作用。一般认为，氨基酸神经递质传递的改变是肿瘤相关性癫痫的最重要机制，细胞外离子的改变也起着重要作用。缺氧、酸中毒以及代谢、免疫和炎症变化也可能与癫痫发作有关。了解这些机制可能为寻找肿瘤相关性癫痫的手术和药物治疗新策略提供指导。
