Englot Dario J, Konrad Peter E, Morgan Victoria L
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A..
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
Epilepsia. 2016 Oct;57(10):1546-1557. doi: 10.1111/epi.13510. Epub 2016 Aug 24.
Epilepsy is among the most common brain network disorders, and it is associated with substantial morbidity and increased mortality. Although focal epilepsy was traditionally considered a regional brain disorder, growing evidence has demonstrated widespread network alterations in this disorder that extend beyond the epileptogenic zone from which seizures originate. The goal of this review is to summarize recent investigations examining functional and structural connectivity alterations in focal epilepsy, including neuroimaging and electrophysiologic studies utilizing model-based or data-driven analytic methods. A significant subset of studies in both mesial temporal lobe epilepsy and focal neocortical epilepsy have demonstrated patterns of increased connectivity related to the epileptogenic zone, coupled with decreased connectivity in widespread distal networks. Connectivity patterns appear to be related to the duration and severity of disease, suggesting progressive connectivity reorganization in the setting of recurrent seizures over time. Global resting-state connectivity disturbances in focal epilepsy have been linked to neurocognitive problems, including memory and language disturbances. Although it is possible that increased connectivity in a particular brain region may enhance the propensity for seizure generation, it is not clear if global reductions in connectivity represent the damaging consequences of recurrent seizures, or an adaptive mechanism to prevent seizure propagation away from the epileptogenic zone. Overall, studying the connectome in focal epilepsy is a critical endeavor that may lead to improved strategies for epileptogenic-zone localization, surgical outcome prediction, and a better understanding of the neuropsychological implications of recurrent seizures.
癫痫是最常见的脑网络疾病之一,与严重的发病率和死亡率增加相关。虽然局灶性癫痫传统上被认为是一种局部脑疾病,但越来越多的证据表明,这种疾病存在广泛的网络改变,其范围超出了癫痫发作起源的致痫区。本综述的目的是总结最近关于局灶性癫痫功能和结构连接改变的研究,包括利用基于模型或数据驱动分析方法的神经影像学和电生理学研究。在内侧颞叶癫痫和局灶性新皮质癫痫的大量研究子集都表明,与致痫区相关的连接性增加模式,同时广泛的远端网络连接性降低。连接模式似乎与疾病的持续时间和严重程度有关,表明随着时间的推移,在反复癫痫发作的情况下,连接性会逐渐重新组织。局灶性癫痫的整体静息态连接性障碍与神经认知问题有关,包括记忆和语言障碍。虽然特定脑区连接性增加可能会增强癫痫发作的倾向,但尚不清楚连接性的整体降低是反复癫痫发作的破坏性后果,还是防止癫痫发作从致痫区传播的一种适应性机制。总体而言,研究局灶性癫痫的连接组是一项关键工作,可能会带来改进的致痫区定位策略、手术结果预测,并更好地理解反复癫痫发作的神经心理学影响。