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边缘性癫痫的生物节律学:内侧颞叶癫痫时间治疗的潜在机制和前景。

Chronobiology of limbic seizures: Potential mechanisms and prospects of chronotherapy for mesial temporal lobe epilepsy.

机构信息

Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University, College Station, Texas, USA; Institute of Biological Sciences and Health, Federal University of Alagoas, Maceio, Alagoas, Brazil.

Faculty of Medicine, Federal University of Alagoas, Maceió, Alagoas, Brazil.

出版信息

Neurosci Biobehav Rev. 2019 Mar;98:122-134. doi: 10.1016/j.neubiorev.2019.01.004. Epub 2019 Jan 7.

Abstract

Mesial Temporal Lobe Epilepsy (mTLE) characterized by progressive development of complex partial seizures originating from the hippocampus is the most prevalent and refractory type of epilepsy. One of the remarkable features of mTLE is the rhythmic pattern of occurrence of spontaneous seizures, implying a dependence on the endogenous clock system for seizure threshold. Conversely, circadian rhythms are affected by epilepsy too. Comprehending how the circadian system and seizures interact with each other is essential for understanding the pathophysiology of epilepsy as well as for developing innovative therapies that are efficacious for better seizure control. In this review, we confer how the temporal dysregulation of the circadian clock in the hippocampus combined with multiple uncoupled oscillators could lead to periodic seizure occurrences and comorbidities. Unraveling these associations with additional research would help in developing chronotherapy for mTLE, based on the chronobiology of spontaneous seizures. Notably, differential dosing of antiepileptic drugs over the circadian period and/or strategies that resynchronize biological rhythms may substantially improve the management of seizures in mTLE patients.

摘要

内侧颞叶癫痫(mTLE)的特征是起源于海马体的复杂部分性发作逐渐发展,是最常见和最难治疗的癫痫类型之一。mTLE 的一个显著特征是自发性发作的节律模式,这意味着其发作阈值依赖于内源性时钟系统。相反,昼夜节律也受癫痫的影响。理解昼夜系统和癫痫如何相互作用对于理解癫痫的病理生理学以及开发有效的创新疗法以更好地控制癫痫发作至关重要。在这篇综述中,我们讨论了海马体中昼夜节律时钟的时间失调如何与多个解耦振荡器结合导致周期性发作的发生和共病。通过进一步的研究揭示这些关联将有助于根据自发性发作的时间生物学开发 mTLE 的时间治疗。值得注意的是,根据昼夜节律调整抗癫痫药物的剂量和/或使生物节律重新同步的策略可能会极大地改善 mTLE 患者的癫痫发作管理。

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