Yuen Alan W C, Keezer Mark R, Sander Josemir W
NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK; Chalfont Centre for Epilepsy, Chalfont St. Peter SL9 0RJ, UK.
NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK; Chalfont Centre for Epilepsy, Chalfont St. Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103SW, The Netherlands; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2L 4M1, Canada.
Epilepsy Behav. 2018 Jan;78:57-61. doi: 10.1016/j.yebeh.2017.10.010. Epub 2017 Nov 22.
The basic pathophysiology of epilepsy is still not fully understood. Epidemiological evidence for epilepsy seems to suggest that it may not only be the propensity for seizures to occur. The high prevalence of comorbidity and the finding that premature mortality is still increased in those who are in long-term remission, suggest that there is a systemic component to the condition. This systemic component is an additional shared risk factor that can explain an important proportion of the comorbidities of epilepsy as well as how an individual with inactive epilepsy remains at an elevated risk of premature mortality. This systemic component can be viewed from the perspective of a number of fundamental pathophysiological processes: inflammation, oxidative stress, glycation, and methylation capacity. These processes are associated with all-cause mortality and there is also a growing understanding of their impact on seizure processes. We propose that epilepsy be considered as the sum of seizures and comorbidities caused by systemic dysfunction, and that the comprehensive management of epilepsy should also include the management of the systemic dysfunction.
癫痫的基本病理生理学仍未被完全理解。癫痫的流行病学证据似乎表明，其可能不仅仅是发作的倾向。共病的高发生率以及长期缓解的患者过早死亡率仍升高这一发现，提示该疾病存在系统性因素。这种系统性因素是一个额外的共同风险因素，它可以解释癫痫共病的很大一部分，以及无发作的癫痫患者为何仍处于过早死亡的高风险中。可以从一些基本病理生理过程的角度来看待这种系统性因素：炎症、氧化应激、糖基化和甲基化能力。这些过程与全因死亡率相关，并且人们对它们对发作过程的影响也有了越来越多的认识。我们建议将癫痫视为由系统性功能障碍引起的发作和共病的总和，并且癫痫的综合管理也应包括对系统性功能障碍的管理。
