Vezzani Annamaria, Fujinami Robert S, White H Steve, Preux Pierre-Marie, Blümcke Ingmar, Sander Josemir W, Löscher Wolfgang
Department of Neuroscience, IRCCS-"Mario Negri" Institute for Pharmacological Research, Milan, Italy.
Department of Pathology, University of Utah, Salt Lake City, UT, USA.
Acta Neuropathol. 2016 Feb;131(2):211-234. doi: 10.1007/s00401-015-1481-5. Epub 2015 Sep 30.
Epilepsy is the tendency to have unprovoked epileptic seizures. Anything causing structural or functional derangement of brain physiology may lead to seizures, and different conditions may express themselves solely by recurrent seizures and thus be labelled "epilepsy." Worldwide, epilepsy is the most common serious neurological condition. The range of risk factors for the development of epilepsy varies with age and geographic location. Congenital, developmental and genetic conditions are mostly associated with the development of epilepsy in childhood, adolescence and early adulthood. Head trauma, infections of the central nervous system (CNS) and tumours may occur at any age and may lead to the development of epilepsy. Infections of the CNS are a major risk factor for epilepsy. The reported risk of unprovoked seizures in population-based cohorts of survivors of CNS infections from developed countries is between 6.8 and 8.3 %, and is much higher in resource-poor countries. In this review, the various viral, bacterial, fungal and parasitic infectious diseases of the CNS which result in seizures and epilepsy are discussed. The pathogenesis of epilepsy due to brain infections, as well as the role of experimental models to study mechanisms of epileptogenesis induced by infectious agents, is reviewed. The sterile (non-infectious) inflammatory response that occurs following brain insults is also discussed, as well as its overlap with inflammation due to infections, and the potential role in epileptogenesis. Furthermore, autoimmune encephalitis as a cause of seizures is reviewed. Potential strategies to prevent epilepsy resulting from brain infections and non-infectious inflammation are also considered.
癫痫是指有发生无端癫痫发作的倾向。任何导致脑生理结构或功能紊乱的因素都可能引发癫痫发作，不同的病症可能仅表现为反复发作，进而被诊断为“癫痫”。在全球范围内，癫痫是最常见的严重神经系统疾病。癫痫发生的危险因素范围因年龄和地理位置而异。先天性、发育性和遗传性疾病大多与儿童期、青少年期和成年早期癫痫的发生有关。头部外伤、中枢神经系统（CNS）感染和肿瘤可发生于任何年龄，并可能导致癫痫的发生。中枢神经系统感染是癫痫的主要危险因素。在发达国家，基于人群的中枢神经系统感染幸存者队列中，无端癫痫发作的报告风险在6.8%至8.3%之间，而在资源匮乏的国家则要高得多。在这篇综述中，我们将讨论导致癫痫发作和癫痫的各种中枢神经系统病毒、细菌、真菌和寄生虫感染性疾病。我们还将综述脑感染所致癫痫的发病机制，以及实验模型在研究感染因子诱导癫痫发生机制中的作用。我们也将讨论脑损伤后发生的无菌性（非感染性）炎症反应，以及它与感染性炎症的重叠，以及在癫痫发生中的潜在作用。此外，我们还将综述自身免疫性脑炎作为癫痫发作原因的情况。我们还将考虑预防脑感染和非感染性炎症所致癫痫的潜在策略。
