Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
The First Clinical Medicine College, Southern Medical University, Guangzhou, China.
Mol Neurobiol. 2021 Jun;58(6):2780-2791. doi: 10.1007/s12035-021-02288-y. Epub 2021 Jan 26.
Epilepsy is a common and serious complication of subarachnoid hemorrhage (SAH), giving rise to increased morbidity and mortality. It's difficult to identify patients at high risk of epilepsy and the application of anti-epileptic drugs (AEDs) following SAH is a controversial topic. Therefore, it's pressingly needed to gain a better understanding of the risk factors, underlying mechanisms and the optimization of therapeutic strategies for epilepsy after SAH. Neuroinflammation, characterized by microglial activation and the release of inflammatory cytokines, has drawn growing attention due to its influence on patients with epilepsy after SAH. In this review, we discuss the risk factors for epilepsy after SAH and emphasize the critical role of microglia. Then we discuss how various molecules arising from pathophysiological changes after SAH activate specific receptors such as TLR4, NLRP3, RAGE, P2X7R and initiate the downstream inflammatory pathways. Additionally, we focus on the significant responses implicated in epilepsy including neuronal excitotoxicity, the disruption of blood-brain barrier (BBB) and the change of immune responses. As the application of AEDs for seizure prophylaxis after SAH remains controversial, the regulation of neuroinflammation targeting the key pathological molecules could be a promising therapeutic method. While neuroinflammation appears to contribute to epilepsy after SAH, more comprehensive experiments on their relationships are needed.
癫痫是蛛网膜下腔出血（SAH）的常见且严重的并发症，导致发病率和死亡率增加。很难确定癫痫风险高的患者，SAH 后应用抗癫痫药物（AEDs）是一个有争议的话题。因此，迫切需要更好地了解 SAH 后癫痫的危险因素、潜在机制和治疗策略的优化。神经炎症的特征是小胶质细胞激活和炎症细胞因子的释放，由于其对 SAH 后癫痫患者的影响，它引起了越来越多的关注。在这篇综述中，我们讨论了 SAH 后癫痫的危险因素，并强调了小胶质细胞的关键作用。然后我们讨论了源自 SAH 后病理生理变化的各种分子如何通过激活特定受体（如 TLR4、NLRP3、RAGE、P2X7R）并启动下游炎症途径来激活特定受体。此外，我们还重点介绍了与癫痫有关的重要反应，包括神经元兴奋性毒性、血脑屏障（BBB）破坏和免疫反应变化。由于 SAH 后应用 AED 预防癫痫发作仍存在争议，针对关键病理分子的神经炎症调节可能是一种有前途的治疗方法。虽然神经炎症似乎是导致 SAH 后癫痫的原因，但需要进行更全面的实验来研究它们之间的关系。
