Shukla Garima, Prasad Asuri N
Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
Epilepsy Res Treat. 2012;2012:195073. doi: 10.1155/2012/195073. Epub 2012 Mar 26.
Temporal lobe epilepsy represents the largest group of patients with treatment resistant/medically intractable epilepsy undergoing epilepsy surgery. The underpinnings of common forms of TLE in many instances begin in early life with the occurrence of an initial precipitating event. The first epileptic seizure often occurs after a variable latency period following this event. The precise natural history and progression following the first seizure to the development of TLE, its subsequent resolution through spontaneous remission or the development of treatment resistant epilepsy remain poorly understood. Our present understanding of the role played by these initial events, the subsequent latency to development of temporal lobe epilepsy, and the emergence of treatment resistance remains incomplete. A critical analysis of published data suggest that TLE is a heterogeneous condition, where the age of onset, presence or absence of a lesion on neuroimaging, the initial precipitating event, association with febrile seizures, febrile status epilepticus, and neurotropic viral infections influence the natural history and outcome. The pathways and processes through which these variables coalesce into a framework will provide the basis for an understanding of the natural history of TLE. The questions raised need to be addressed in future prospective and longitudinal observational studies.
颞叶癫痫是接受癫痫手术的难治性/药物难治性癫痫患者中最大的群体。在许多情况下，常见形式的颞叶癫痫的根源始于生命早期，发生了最初的诱发事件。第一次癫痫发作通常在该事件后的可变潜伏期后发生。从第一次发作到颞叶癫痫发展的精确自然史和进展，以及其随后通过自发缓解或发展为药物难治性癫痫的解决情况，仍然知之甚少。我们目前对这些初始事件所起的作用、随后发展为颞叶癫痫的潜伏期以及药物难治性的出现的理解仍然不完整。对已发表数据的批判性分析表明，颞叶癫痫是一种异质性疾病，发病年龄、神经影像学上是否存在病变、初始诱发事件、与热性惊厥、热性癫痫持续状态以及嗜神经病毒感染的关联会影响自然史和预后。这些变量整合到一个框架中的途径和过程将为理解颞叶癫痫的自然史提供基础。提出的问题需要在未来的前瞻性和纵向观察性研究中加以解决。
