Yerkes National Primate Research Center, Emory University, 954 Gatewood Road NE, Atlanta, GA, 30329, USA.
Department of Neurology, Emory University, Atlanta, GA, 30322, USA.
J Neural Transm (Vienna). 2018 Mar;125(3):531-545. doi: 10.1007/s00702-017-1768-x. Epub 2017 Aug 1.
Epilepsy is a network disorder and each type of seizure involves distinct cortical and subcortical network, differently implicated in the control and propagation of the ictal activity. The role of the basal ganglia has been revealed in several cases of focal and generalized seizures. Here, we review the data that show the implication of the basal ganglia in absence, temporal lobe, and neocortical seizures in animal models (rodent, cat, and non-human primate) and in human. Based on these results and the advancement of deep brain stimulation for Parkinson's disease, basal ganglia neuromodulation has been tested with some success that can be equally seen as promising or disappointing. The effect of deep brain stimulation can be considered promising with a 76% in seizure reduction in temporal lobe epilepsy patients, but also disappointing, since only few patients have become seizure free and the antiepileptic effects have been highly variable among patients. This variability could probably be explained by the heterogeneity among the patients included in these clinical studies. To illustrate the importance of specific network identification, electrophysiological activity of the putamen and caudate nucleus has been recorded during penicillin-induced pre-frontal and motor seizures in one monkey. While an increase of the firing rate was found in putamen and caudate nucleus during pre-frontal seizures, only the activity of the putamen cells was increased during motor seizures. These preliminary results demonstrate the implication of the basal ganglia in two types of neocortical seizures and the necessity of studying the network to identify the important nodes implicated in the propagation and control of each type of seizure.
癫痫是一种网络紊乱，每种类型的癫痫发作都涉及到不同的皮质和皮质下网络，这些网络在癫痫活动的控制和传播中起着不同的作用。基底神经节在几种局灶性和全身性癫痫发作中都有作用。在这里，我们回顾了一些数据，这些数据表明基底神经节在动物模型（啮齿动物、猫和非人类灵长类动物）和人类中参与了失神、颞叶和新皮质癫痫发作。基于这些结果和深部脑刺激治疗帕金森病的进展，基底神经节神经调节已经取得了一些成功的测试，这些结果可以被视为有前途的，也可以被视为令人失望的。深部脑刺激的效果可以被认为是有前途的，因为它使颞叶癫痫患者的癫痫发作减少了 76%，但也令人失望，因为只有少数患者癫痫发作完全消失，而且抗癫痫效果在患者之间差异很大。这种可变性可能是由于这些临床研究中纳入的患者存在异质性造成的。为了说明特定网络识别的重要性，在一只猴子身上记录了青霉素诱导的前额叶和运动性癫痫发作期间的壳核和尾状核的电生理活动。虽然在前额叶癫痫发作时，壳核和尾状核的放电率增加，但只有在运动性癫痫发作时，壳核细胞的活动才增加。这些初步结果表明基底神经节参与了两种新皮质癫痫发作，并需要研究网络以确定在每种癫痫发作的传播和控制中涉及的重要节点。
