Department of Neurosurgery, Indiana University, Bloomington, IN, USA.
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Nat Rev Neurol. 2024 May;20(5):298-312. doi: 10.1038/s41582-024-00954-y. Epub 2024 Apr 3.
Post-traumatic epilepsy (PTE) accounts for 5% of all epilepsies. The incidence of PTE after traumatic brain injury (TBI) depends on the severity of injury, approaching one in three in groups with the most severe injuries. The repeated seizures that characterize PTE impair neurological recovery and increase the risk of poor outcomes after TBI. Given this high risk of recurrent seizures and the relatively short latency period for their development after injury, PTE serves as a model disease to understand human epileptogenesis and trial novel anti-epileptogenic therapies. Epileptogenesis is the process whereby previously normal brain tissue becomes prone to recurrent abnormal electrical activity, ultimately resulting in seizures. In this Review, we describe the clinical course of PTE and highlight promising research into epileptogenesis and treatment using animal models of PTE. Clinical, imaging, EEG and fluid biomarkers are being developed to aid the identification of patients at high risk of PTE who might benefit from anti-epileptogenic therapies. Studies in preclinical models of PTE have identified tractable pathways and novel therapeutic strategies that can potentially prevent epilepsy, which remain to be validated in humans. In addition to improving outcomes after TBI, advances in PTE research are likely to provide therapeutic insights that are relevant to all epilepsies.
创伤后癫痫（PTE）占所有癫痫的 5%。颅脑损伤（TBI）后 PTE 的发病率取决于损伤的严重程度，在损伤最严重的人群中，接近三分之一的人会发生 PTE。PTE 反复发作会损害神经恢复，并增加 TBI 后不良结局的风险。鉴于反复发生癫痫的高风险以及损伤后其发展的潜伏期相对较短，PTE 是理解人类癫痫发生和试验新型抗癫痫发生治疗的模型疾病。癫痫发生是指原本正常的脑组织变得容易反复出现异常电活动，最终导致癫痫发作的过程。在这篇综述中，我们描述了 PTE 的临床过程，并强调了使用 PTE 动物模型进行癫痫发生和治疗的有前途的研究。正在开发临床、影像学、脑电图和液体生物标志物，以帮助识别 PTE 风险高的患者，这些患者可能受益于抗癫痫发生治疗。在 PTE 的临床前模型中进行的研究已经确定了可行的途径和新的治疗策略，这些途径和策略有可能预防癫痫，这些仍有待在人类中验证。除了改善 TBI 后的结局外，PTE 研究的进展还有望为所有癫痫提供相关的治疗见解。
