Lam Alice D, Cole Andrew J, Cash Sydney S
Massachusetts General Hospital, Department of Neurology, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
Front Neurol. 2019 Sep 4;10:959. doi: 10.3389/fneur.2019.00959. eCollection 2019.
Silent seizures were discovered in mouse models of Alzheimer's disease over 10 years ago, yet it remains unclear whether these seizures are a salient feature of Alzheimer's disease in humans. Seizures that arise early in the course of Alzheimer's disease most likely originate from the mesial temporal lobe, one of the first structures affected by Alzheimer's disease pathology and one of the most epileptogenic regions of the brain. Several factors greatly limit our ability to identify mesial temporal lobe seizures in patients with Alzheimer's disease, however. First, mesial temporal lobe seizures can be difficult to recognize clinically, as their accompanying symptoms are often subtle or even non-existent. Second, electrical activity arising from the mesial temporal lobe is largely invisible on the scalp electroencephalogram (EEG), the mainstay of diagnosis for epilepsy in this population. In this review, we will describe two new approaches being used to study silent mesial temporal lobe seizures in Alzheimer's disease. We will first describe the methodology and application of foramen ovale electrodes, which captured the first recordings of silent mesial temporal lobe seizures in humans with Alzheimer's disease. We will then describe machine learning approaches being developed to non-invasively identify silent mesial temporal lobe seizures on scalp EEG. Both of these tools have the potential to elucidate the role of silent seizures in humans with Alzheimer's disease, which could have important implications for early diagnosis, prognostication, and development of targeted therapies for this population.
10多年前，在阿尔茨海默病的小鼠模型中发现了无症状性癫痫发作，但目前仍不清楚这些癫痫发作是否是人类阿尔茨海默病的一个显著特征。在阿尔茨海默病病程早期出现的癫痫发作很可能起源于内侧颞叶，内侧颞叶是最早受阿尔茨海默病病理影响的结构之一，也是大脑中最易引发癫痫的区域之一。然而，有几个因素极大地限制了我们识别阿尔茨海默病患者内侧颞叶癫痫发作的能力。首先，内侧颞叶癫痫发作在临床上可能很难识别，因为其伴随症状往往很轻微甚至不存在。其次，内侧颞叶产生的电活动在头皮脑电图（EEG）上基本不可见，而头皮脑电图是该人群癫痫诊断的主要手段。在这篇综述中，我们将描述两种用于研究阿尔茨海默病无症状性内侧颞叶癫痫发作的新方法。我们将首先描述卵圆孔电极的方法和应用，卵圆孔电极首次记录了阿尔茨海默病患者无症状性内侧颞叶癫痫发作。然后，我们将描述正在开发的机器学习方法，以非侵入性地识别头皮脑电图上的无症状性内侧颞叶癫痫发作。这两种工具都有可能阐明无症状性癫痫发作在阿尔茨海默病患者中的作用，这可能对该人群的早期诊断、预后以及靶向治疗的开发具有重要意义。
