Zappoli R, Papini M, Pasquinelli A, Martinetti M G, Guerri S, Thyrion E Z
Riv Patol Nerv Ment. 1977 Mar-Apr;98(2):119-32.
Two cases have been studied by means of the usual method for eliciting CNV (S-1.5 OR 1 SEC-S-operant response) during and after the end of an episode of prolonged epileptic twilight state with almost continuous strictly unilateral temporal lobe discharge. From the clinical viewpoint in both cases the twilight state, lasting respectively about 12 and 48 hours, was characterized by a slightly clouded consciousness and moderate impairment of awareness and of psychic performances, at times associated with simple and complex psychomotor automatism and hallucinations. The EEG recorded an almost continous left temporal discharge of pseudorhythmic mixed slow waves and sharps. The third case had typical prolonged petit mal states with continuous spike-and-slow-wave activity, impaired intellectual and motor performances (very long reaction time etc.). In this patient for eliciting ERSPs, besides the standard method, we have used a paradigm in which S consisted of a colored slide, with various semantic contents, remaining visible for 5 seconds on a screen. At the trials of the standard paradigm during the epiliptic twilight state, all patients showed they had understood the signal to interrupt (S loud repetitive tone) in the shortest time possible and could clearly distinguish them from the S. The operant response was almost always made with sufficient precision and sometimes with fairly short reaction time, especially by the patients with temporal psychomotor status. During the episodes of prolonged clouded consciosness in all series of trials administered to the patients, no negative slow potential shifts were observed in the averaged EEG recordings obtained from F-T, F-T or F, FCZ and referred to to linked mastoids. On repetition of the examinations some time after the end of the epileptic twilight state, fairly normal ERSPs were obtained in all cases. Taking also into account the results of previous researches, these studies show that the temporal lobe and "centrencephalic" epileptic discharges, under certain conditions, may influence negatively the neurophysiological mechanisms which contribute to the information of complex contingent connections and which also underly the particular attentional, cognitive and sensorimotor functions involved in the inhibiting the appearance of ERSPs probably related to more specific perceptual and integrative functions. Some AA. maintain that negative slow potential shifts express the functional activity of the brain structures, particularly of determined cerebral cortex regions, involved not only in attentional, perceptual, cognitive and psychomotor functioning, but also in information processing (memory recording mechanism). Hence, the negative influence of prolonged temporal lobe or meso-diencephalic epileptic discharges on these structures may explain the almost complete amnesia that patients generally show at the termination of this kind of twilight state.
通过常用方法(S-1.5或1秒-S操作性反应),对两例在长时间癫痫朦胧状态发作期间及结束后出现几乎持续的严格单侧颞叶放电的病例进行了研究。从临床角度看,两例患者的朦胧状态分别持续约12小时和48小时,其特征为意识稍有模糊、意识及心理活动有中度损害,有时伴有简单和复杂的精神运动自动症及幻觉。脑电图记录显示左侧颞叶有几乎持续的伪节律性混合慢波和尖波放电。第三例患者有典型的长时间小发作状态,伴有持续的棘慢波活动,智力和运动功能受损(反应时间极长等)。在该患者身上,为引出事件相关频谱功率(ERSPs),除了标准方法外,我们还采用了一种范式,其中S为一张带有各种语义内容的彩色幻灯片,在屏幕上可见5秒。在癫痫朦胧状态下进行标准范式试验时,所有患者都表明他们能在尽可能短的时间内理解中断信号(S大声重复音调),并能将其与S清晰区分。操作性反应几乎总是相当精确,有时反应时间相当短,尤其是颞叶精神运动状态的患者。在对患者进行的所有系列试验中,在长时间意识模糊发作期间,从额颞(F-T)、额颞(F-T)或额中央(F,FCZ)导联记录并参考双侧乳突导联获得的平均脑电图记录中,未观察到负向慢电位偏移。在癫痫朦胧状态结束后的一段时间重复检查时,所有病例均获得了相当正常的ERSPs。综合先前研究的结果,这些研究表明,在某些情况下,颞叶和“中央脑”癫痫放电可能对神经生理机制产生负面影响,这些机制有助于形成复杂的偶然联系信息,也是抑制可能与更特定的感知和整合功能相关的ERSPs出现所涉及的特定注意、认知和感觉运动功能的基础。一些研究人员认为,负向慢电位偏移表达了大脑结构的功能活动,特别是某些特定的大脑皮层区域,这些区域不仅参与注意、感知、认知和精神运动功能,还参与信息处理(记忆记录机制)。因此,长时间的颞叶或中脑间脑癫痫放电对这些结构的负面影响可能解释了患者在这种朦胧状态结束时通常表现出的几乎完全失忆。