Banerjee Jyotirmoy, Chandra Sarat P, Kurwale Nilesh, Tripathi Manjari
Centre of Excellence for Epilepsy Research (A NBRC-AIIMS Collaboration), New Delhi, India.
Centre of Excellence for Epilepsy Research (A NBRC-AIIMS Collaboration), New Delhi, India ; Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Ann Indian Acad Neurol. 2014 Mar;17(Suppl 1):S134-40. doi: 10.4103/0972-2327.128688.
A multidisciplinary approach is required to understand the complex intricacies of drug-resistant epilepsy (DRE). A challenge that neurosurgeons across the world face is accurate localization of epileptogenic zone. A significant number of patients who have undergone resective brain surgery for epilepsy still continue to have seizures. The reason behind this therapy resistance still eludes us. Thus to develop a cure for the difficult to treat epilepsy, we need to comprehensively study epileptogenesis. Till date, most of the studies on DRE is focused on undermining the abnormal functioning of receptors involved in synaptic transmission and reduced levels of antiepileptic drugs around there targets. But recent advances in imaging and electrophysiological techniques have suggested the role epileptogenic networks in the process of epileptogenesis. According to this hypothesis, the local neurons recruit distant neurons through complex oscillatory circuits, which further recruit more distant neurons, thereby generating a hypersynchronus neuronal activity. The epileptogenic networks may be confined to the lesion or could propagate to distant focus. The success of surgery depends on the precision by which the epileptogenic network is determined while planning a surgical intervention. Here, we summarize various modalities of electrophysiological and imaging techniques to determine the functionally active epileptogenic networks. We also review evidence pertaining to the proposed role of epileptogenic network in abnormal synaptic transmission which is one of the major causes of epileptiform activity. Elucidation of current concepts in regulation of synaptic transmission by networks will help develop therapies for epilepsy cases that cannot be managed pharmacologically.
需要采用多学科方法来理解耐药性癫痫(DRE)的复杂细节。世界各地的神经外科医生面临的一个挑战是癫痫病灶区的准确定位。大量接受癫痫切除性脑手术的患者仍继续发作。这种治疗抵抗背后的原因仍然不明。因此,为了开发治疗难治性癫痫的方法,我们需要全面研究癫痫发生机制。迄今为止,大多数关于DRE的研究都集中在破坏参与突触传递的受体的异常功能以及其靶点周围抗癫痫药物水平的降低。但成像和电生理技术的最新进展表明癫痫发生网络在癫痫发生过程中的作用。根据这一假设,局部神经元通过复杂的振荡回路招募远处的神经元,而远处的神经元又进一步招募更远的神经元,从而产生超同步神经元活动。癫痫发生网络可能局限于病灶,也可能传播到远处的病灶。手术的成功取决于在规划手术干预时确定癫痫发生网络的精确程度。在此,我们总结了各种电生理和成像技术模式,以确定功能活跃的癫痫发生网络。我们还回顾了与癫痫发生网络在异常突触传递中所起作用相关的证据,而异常突触传递是癫痫样活动的主要原因之一。阐明当前关于网络调节突触传递的概念将有助于开发针对无法通过药物治疗的癫痫病例的疗法。