Gummadavelli Abhijeet, Martin Reese, Goshay Derek, Sieu Lim-Anna, Xu Jingwen, Gruenbaum Benjamin F, McCafferty Cian, Gerrard Jason L, Blumenfeld Hal
Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Epilepsia. 2021 Aug;62(8):1960-1970. doi: 10.1111/epi.16964. Epub 2021 Jul 9.
Impairment in consciousness is a debilitating symptom during and after seizures; however, its mechanism remains unclear. Limbic seizures have been shown to spread to arousal circuitry to result in a "network inhibition" phenomenon. However, prior animal model studies did not relate physiological network changes to behavioral responses during or following seizures.
Focal onset limbic seizures were induced while rats were performing an operant conditioned behavioral task requiring response to an auditory stimulus to quantify how and when impairment of behavioral response occurs. Correct responses were rewarded with sucrose. Cortical and hippocampal electrophysiology measured by local field potential recordings was analyzed for changes in low- and high-frequency power in relation to behavioral responsiveness during seizures.
As seen in patients with seizures, ictal (p < .0001) and postictal (p = .0015) responsiveness was variably impaired. Analysis of cortical and hippocampal electrophysiology revealed that ictal (p = .002) and postictal (p = .009) frontal cortical low-frequency 3-6-Hz power was associated with poor behavioral performance. In contrast, the hippocampus showed increased power over a wide frequency range during seizures, and suppression postictally, neither of which were related to behavioral impairment.
These findings support prior human studies of temporal lobe epilepsy as well as anesthetized animal models suggesting that focal limbic seizures depress consciousness through remote network effects on the cortex, rather than through local hippocampal involvement. By identifying the cortical physiological changes associated with impaired arousal and responsiveness in focal seizures, these results may help guide future therapies to restore ictal and postictal consciousness, improving quality of life for people with epilepsy.
意识障碍是癫痫发作期间及之后的一种使人衰弱的症状;然而,其机制仍不清楚。边缘叶癫痫发作已被证明会扩散到觉醒回路,导致“网络抑制”现象。然而,先前的动物模型研究并未将癫痫发作期间或之后的生理网络变化与行为反应联系起来。
在大鼠执行一项操作性条件行为任务时诱发局灶性发作的边缘叶癫痫,该任务要求对听觉刺激做出反应,以量化行为反应受损的方式和时间。正确反应会得到蔗糖奖励。通过局部场电位记录测量皮质和海马的电生理,分析癫痫发作期间低频和高频功率与行为反应性相关的变化。
正如在癫痫患者中所见,发作期(p <.0001)和发作后期(p =.0015)的反应性有不同程度的受损。对皮质和海马电生理的分析显示,发作期(p =.002)和发作后期(p =.009)额叶皮质低频3 - 6赫兹功率与行为表现不佳有关。相比之下,海马在癫痫发作期间在很宽的频率范围内功率增加,发作后则受到抑制,这两者均与行为损伤无关。
这些发现支持了先前对颞叶癫痫的人体研究以及麻醉动物模型的研究,表明局灶性边缘叶癫痫发作通过对皮质的远程网络效应而非局部海马参与来抑制意识。通过识别与局灶性癫痫发作中觉醒和反应性受损相关的皮质生理变化,这些结果可能有助于指导未来恢复发作期和发作后期意识的治疗方法,改善癫痫患者的生活质量。