Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Epilepsia Open. 2022 Aug;7 Suppl 1(Suppl 1):S59-S67. doi: 10.1002/epi4.12565. Epub 2021 Dec 17.
Drug-resistant epilepsy (DRE) affects approximately one-third of the patients with epilepsy. Based on experimental findings from animal models and brain tissue from patients with DRE, different hypotheses have been proposed to explain the cause(s) of drug resistance. One is the intrinsic severity hypothesis that posits that drug resistance is an inherent property of epilepsy related to disease severity. Seizure frequency is one measure of epilepsy severity, but frequency alone is an incomplete measure of severity and does not fully explain basic research and clinical studies on drug resistance; thus, other measures of epilepsy severity are needed. One such measure could be pathological high-frequency oscillations (HFOs), which are believed to reflect the neuronal disturbances responsible for the development of epilepsy and the generation of spontaneous seizures. In this manuscript, we will briefly review the intrinsic severity hypothesis, describe basic and clinical research on HFOs in the epileptic brain, and based on this evidence discuss whether HFOs could be a clinical measure of epilepsy severity. Understanding the mechanisms of DRE is critical for producing breakthroughs in the development and testing of novel strategies for treatment.
耐药性癫痫（DRE）影响约三分之一的癫痫患者。基于动物模型和 DRE 患者脑组织的实验发现，提出了不同的假说来解释耐药的原因。一种是内在严重程度假说，该假说认为耐药性是与疾病严重程度相关的癫痫的固有特性。发作频率是癫痫严重程度的一种衡量标准，但频率本身是严重程度的不完整衡量标准，并且不能完全解释耐药性的基础研究和临床研究；因此，需要其他衡量癫痫严重程度的标准。其中一个标准可能是病理性高频振荡（HFOs），据信它反映了导致癫痫发作和自发性发作的神经元紊乱。在本文中，我们将简要回顾内在严重程度假说，描述癫痫脑中 HFOs 的基础和临床研究，并根据这些证据讨论 HFOs 是否可以作为癫痫严重程度的临床衡量标准。了解 DRE 的机制对于开发和测试新的治疗策略的突破至关重要。
