Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Seizure. 2023 Aug;110:220-230. doi: 10.1016/j.seizure.2023.06.020. Epub 2023 Jun 24.
Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
根据 DSM-5，解离是“意识、记忆、身份或对环境的感知的通常整合功能的中断”。它在包括原发性解离障碍、创伤后应激障碍、抑郁症和惊恐障碍在内的精神障碍中很常见。在物质中毒、睡眠剥夺和包括创伤性脑损伤、偏头痛和癫痫在内的医学疾病的背景下，也描述了分离现象。与健康对照组相比，癫痫患者在分离体验量表上的分离体验发生率更高。癫痫发作的症状，特别是起源于颞叶的局灶性癫痫发作，可能包括类似分离的体验，如即视感/错视感、人格解体、现实解体和被描述为“梦幻状态”。这些描述在起源于内侧颞叶癫痫的癫痫发作中很常见，可能涉及杏仁核和海马体。其他癫痫发作时的分离现象包括自动感和出体体验，这被认为是由于负责整合自身身体和外部空间的网络中断引起的，涉及颞顶联合区和后岛叶。在本叙述性综述中，我们将总结关于癫痫中分离体验以及功能性癫痫中分离体验的最新文献。我们将通过一个案例回顾来复习分离症状的鉴别诊断。我们还将回顾不同诊断实体中分离症状的神经生物学基础，并讨论癫痫发作时的症状如何揭示包括意识和自我认同的主观性质在内的复杂心理过程的神经生物学。
