Klein Pavel, Carrazana Enrique, Glauser Tracy, Herman Bruce P, Penovich Patricia, Rabinowicz Adrian L, Sutula Thomas P
Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA.
John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Epilepsy Curr. 2025 Apr 16:15357597251331927. doi: 10.1177/15357597251331927.
In 1885, William Gowers proposed that epilepsy is a progressive disease, based on clinical evidence before any effective treatments were available. His long-standing hypothesis has been summarized with the statement "seizures beget seizures." Whether this is the case and related questions about seizure-induced modification and damage of brain circuits are of fundamental importance for neurobiological understanding of epilepsy, development of effective treatment strategies, clinical management, and prognostication. Consensus about progression and seizure-induced damage has remained controversial. Here, we critically review these long-standing questions, incorporating perspectives about perceived inconsistencies in past studies, potential implications of recent longitudinal imaging and cognitive studies, and emphasize experimental and clinical gaps that have proved challenging. Answers to these questions are important for development of management strategies to achieve prompt effective acute control of seizures and prevention of their potential recurrence and long-term comorbidities.
1885年，威廉·高尔斯在尚无任何有效治疗方法的情况下，基于临床证据提出癫痫是一种进行性疾病。他长期以来的假说被概括为“发作引发发作”。情况是否如此，以及与发作引起的脑回路改变和损伤相关的问题，对于从神经生物学角度理解癫痫、制定有效的治疗策略、临床管理和预后判断至关重要。关于疾病进展和发作引起的损伤的共识一直存在争议。在此，我们批判性地审视这些长期存在的问题，纳入对过去研究中明显矛盾之处的观点、近期纵向影像学和认知研究的潜在影响，并强调已证明具有挑战性的实验和临床差距。这些问题的答案对于制定管理策略以迅速有效地急性控制发作并预防其潜在复发和长期合并症很重要。
