颞叶癫痫中的过度运动性发作(附2例报告)

目的过度运动性发作常见于额叶癫痫,总结我中心病例,探讨颞叶癫痫表现为过度运动性发作时的临床决策。方法回顾2007～2009年进行手术治疗的颞叶癫痫患者,对所有患者的术前评估资料包括病史、MRI、头皮视频脑电图、PET和颅内脑电记录进行回顾性分析。根据Luders的描述对过度运动性发作进行识别。结果 102例患者中有2例表现为典型的过度运动性发作,尽管症状学提示额叶起源,但是头皮脑电图均提示颞叶为发作起始区,1例进行颅内电极监测,另1例因为MRI的阳性发现而直接进行手术切除。2例患者进行了前颞叶切除术,术后2 a以上无发作。结论过度运动性发作发作偶尔可见于颞叶癫痫,如果其头皮EEG结果与影像学检查一致,则手术治疗效果比较理想。     

Symptomatic postictal cardiac asystole in a young patient with partial seizures.

This report describes a patient with complex partial seizures arising from the right temporal lobe who developed symptomatic sinus arrest following the end of his seizure activity. A ventricular pacemaker was implanted and was documented to function appropriately, preventing development of bradycardia associated symptoms during subsequent seizures. Possibly relevant cerebral structures are briefly discussed.     

Psychomotor development and seizure features in idiopathic myoclonic epilepsy in infancy

Myoclonic epilepsy in infancy (MEI) is a rare syndrome characterized by generalized myoclonic seizures (MS) that occur within the first 3 years of life. In the present study, the form of onset, and clinical and electroencephalogram (EEG) features were analyzed. A retrospective chart review was conducted for 16 MEI patients between March 2009 and July 2022 in Peking Union Medical College. The clinical and video EEG (VEEG) characteristics, treatment strategy, and follow-up information were analyzed. Four cases presented with afebrile generalized tonic-clonic seizures (GTCS) at the onset of MEI (GTCS at onset or atypical MEI), while 12 cases presented with MS at onset (MS at onset or typical MEI). The 24-hour VEEG revealed a generalized discharge of polyspike (or spike)-and-wave complexes that lasted for 1–3 seconds in the ictal phase. All patients were treated with valproic acid monotherapy, and none of the patients experienced seizure recurrence. Furthermore, all patients had normal psychomotor development at the end of the follow up period. Typical MEI (MS at onset) and atypical MEI (GTCS at onset) were described in the present study. These 2 groups differed in form of onset, but there were no significant differences in clinical or EEG features.     

涟波振荡与大鼠颞叶癫癎发作关系的研究

目的探讨脑电中的涟波振荡与大鼠颞叶癫癎发作的关系。方法10只SD大鼠,在双侧齿状回和海马分别置入深部电极,用氯化锂-毛果芸香碱腹腔注射诱发大鼠颞叶癫癎,记录癫癎发作前后的深部脑电(采样频率10KHz,低通为5000Hz)。用小波变换提取脑电中的涟波和快速涟波成分,并用能量法对癫癎发作前后的涟波成分进行分析。结果涟波和快速涟波的能量变化与癫癎发作的状态十分符合。癫癎发作时,快速涟波和涟波的能量都有明显增加,累积速率大。给予地西泮后,两者的能量都有所减小,累积速率趋于稳定,但快速涟波的能量累积速度降低得更快。结论脑电中的涟波振荡成分对癫癎发作有指示性作用。     

前颞叶内侧切除术治疗颞叶内侧型癫痫

目的探讨前颞叶内侧切除术治疗颞叶内侧型癫痫的治疗效果。方法21例顽固性颞叶癫痫患者,采用无框架神经导航辅助,经颞中回行前颞叶内侧切除术,切除前颞叶、杏仁核及海马。采用分级量表进行针对癫痫发作控制效果的评价。结果21例术后随访6～29个月,神经功能均改善,无严重手术并发症。16例（76%）癫痫发作完全消失（EngelⅠ级）,3例（16%）癫痫发作极少（EngelⅡ级）,2例（8%）癫痫发作减少（EngelⅢ级）。结论前颞叶内侧切除术是治疗颞叶癫痫的有效方法。神经导航辅助下手术彻底切除杏仁核及海马,避免了语言区和视放射的损伤。     

Temporal-insular spreading time in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy

Insular involvement in temporal lobe epilepsy (TLE) has gradually been recognized since the widespread use of stereoelectroencephalography (SEEG). However, the correlation between insular involvement and failed temporal lobe surgery remains unclear. In this study, we analyzed the surgical outcomes of TLE patients who underwent temporal and insular SEEG recordings and explored the predictors of failed anterior temporal lobectomy (ATL) in these patients with temporal seizures.Forty-one patients who underwent ATL for drug-resistant TLE were examined using temporal and insular SEEG recordings. The clinical characteristics, SEEG data, and postoperative seizure outcomes of these patients were analyzed, and multivariate analysis was used to identify the predictors of surgical outcome.In this series, the ictal temporal discharges invaded the insula in 39 (95.1%) patients. Twenty-three (56.1%) patients were seizure-free (Engel class I) after ATL with at least 1 year follow-up. Only temporal-insular spreading time (TIST) was an independent predictor of postoperative seizure-free outcomes (P = .035). By creating receiver operating characteristic curves for TIST, 400 milliseconds was identified as the cutoff for classification. All patients were classified into 2 groups (TIST ≤ 400 milliseconds and TIST > 400 milliseconds) based on the cutoff value; the difference in seizure-free rates between the 2 groups was significant (P = .001).The very early insular involvement in TLE may be associated with poorer seizure outcomes after ATL. Our findings may be helpful for estimating the appropriate operative procedures and will be valuable for evaluating the prognosis of TLE patients with temporal-insular SEEG recordings and temporal lobectomy.     

颞叶癫痫术前定位方法的评价

目的 探讨颞叶癫痫不同术前定位方法的效果。方法 回顾性分析58例难治性颞叶癫痫手术患者的临床资料。分别统计头皮脑电图、视频脑电监测、皮层电极、深部电极、头颅CT、MR1、PET七种检查定位方法的阳性结果,计算出准确定位率,对数据进行统计学分析。结果 CT、头皮脑电图的定位能力明显低于视频脑电监测、皮层电极、深部电极监测及MRI、PET检查,后五种评估方法的定位能力无显著差异。结论 上述术前定位方法单一应用不具有特异性．颞叶癫痫灶的准确定位需综合应用各种定位方法。     

褪黑素对匹罗卡品致癫癎大鼠海马神经发生和突触重建的影响

目的探讨褪黑素(Mel)在匹罗卡品(PILO)致癫癎犬鼠模型中的抗癫癎作用机制。方法将45只Wistar大鼠按癫癎持续状态(SE)后6 h,14、28天分为PILO组(1 5只),PILO+Mel组(15只)和对照组(15只),采用PILO诱导大鼠慢性颞叶癫癎模型,用5溴-2-脱氧尿嘧啶核苷标记增殖细胞,Timms染色评价苔藓纤维发芽(MFS)等技术,动态观察MeI对癫癎大鼠海马神经发生和MFS的影响及其与反复自发性癫癎发作(SRS)发生的关系。结果与对照组比较,PILO组大鼠SE后6 h,14、28天细胞数明显增加,差异有统计学意义(P<0.01);与PILO组比较,PILO+Mel组大鼠在SE后6 h,14、28天,细胞数量明显减少(P<0.05),28天SRS数量明显减少,差异有统计学意义(P<0.05)。与PILO+Mel组比较,PILO组大鼠SE后14天,Timms染色密度开始增强,28天密度明显增强,差异有统计学意义(P<0.05)。结论Mel对SRS的预防作用可能与其对癫癎诱导的神经发生和MFS的抑制作用有关。     

Serum prolactin level and lactate dehydrogenase activity in patients with epileptic and nonepileptic seizures: A cross-sectional study

It is important to diagnose epilepsy in a timely and accurate manner, and also to distinguish it from non-epileptic conditions. The present study was aimed at determining postictal serum prolactin levels and lactate dehydrogenase (LDH) activities in patients with new-onset seizure admitted to the emergency department in order to assess whether they could be used in the differentiation of epileptic seizure (ES) from nonepileptic seizure (NES).Eighty-five patients were included prospectively in this study. Patients were divided into 2 groups with respect to epilepsy diagnosis, and the final groups were comprised of 36 patients with ES and 49 patients with NES. Blood samples were obtained within 1 hour of seizure.No significant differences between groups were observed in prolactin levels and in the percentage of patients with abnormal prolactin level (P = .569 and .239, respectively). The median LDH activity was significantly higher in those with ES compared with those with NES (P = .031). The percentage of patients with elevated LDH levels was similar between 2 groups (P = .286).This was the first study to examine LDH activities in terms of its role in differentiation of seizure origin in the postictal period in patients hospitalized with seizure. Our study demonstrated that serum LDH activities within 1 hour after the seizure appear to be increased in patients with ES compared with those with NES, suggesting the potential role of LDH activities as a diagnostic tool in distinction of seizure types. Our study supports the hypothesis that LDH-antagonists may have a role in the management of seizure and epilepsy.     

BDNF modulates GABAA receptors microtransplanted from the human epileptic brain to Xenopus oocytes

Cell membranes isolated from brain tissues, obtained surgically from six patients afflicted with drug-resistant temporal lobe epilepsy and from one nonepileptic patient afflicted with a cerebral oligodendroglioma, were injected into frog oocytes. By using this approach, the oocytes acquire human GABAA receptors, and we have shown previously that the "epileptic receptors" (receptors transplanted from epileptic brains) display a marked run-down during repetitive applications of GABA. It was found that exposure to the neurotrophin BDNF increased the amplitude of the "GABA currents" (currents elicited by GABA) generated by the epileptic receptors and decreased their run-down; both events being blocked by K252A, a neurotrophin tyrosine kinase receptor B inhibitor. These effects of BDNF were not mimicked by nerve growth factor. In contrast, the GABAA receptors transplanted from the nonepileptic human hippocampal uncus (obtained during surgical resection as part of the nontumoral tissue from the oligodendroglioma margins) or receptors expressed by injecting rat recombinant alpha1beta2gamma2 GABAA receptor subunit cDNAs generated GABA currents whose time-course and run-down were not altered by BDNF. Loading the oocytes with the Ca2+ chelator 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetate-acetoxymethyl ester (BAPTA-AM), or treating them with Rp-8-Br-cAMP, an inhibitor of the cAMP-dependent PKA, did not alter the GABA currents. However, staurosporine (a broad spectrum PK inhibitor), bisindolylmaleimide I (a PKC inhibitor), and U73122 (a phospholipase C inhibitor) blocked the BDNF-induced effects on the epileptic GABA currents. Our results indicate that BDNF potentiates the epileptic GABAA currents and antagonizes their use-dependent run-down, thus strengthening GABAergic inhibition, probably by means of activation of tyrosine kinase receptor B receptors and of both PLC and PKC.     

Psychomotor seizures in infants and young children

off authors analyzed the ictal clinical symptoms (in 6 cases with videotape monitoring) of 12 infants and young children, who had focal epileptic discharges in the temporal regions (fig. 3, 4, 5). The average age was 1 9/12 years with a range of 3 months to 5 years. In 6 cases the seizures were typical "psychomotor" with oral automatisms, aimless movements of the upper extremities and/or tonic versive motor manifestations (fig. 2). In 5 cases the seizures consisted of staring and arrest of any movement. In another case, automatisms of the upper extremities were accompanied by a psychomotor arrest reaction. It is probable that in this age group seizures with sudden arrest of activity ("temporal pseudoabsences") are more frequently the main expression of partial complex seizures than in older children and in adults.     

颞叶癫痫大鼠学习记忆障碍与海马病理变化的相关性研究

目的 探讨大鼠颞叶癫痫发作后不同时问学习、记忆障碍程度与海马病理变化的相关性。方法 采用立体定向技术在大鼠右侧海马注射红藻氨酸诱发颡叶癫痫发作,观察其行为学表现、脑电图变化,Morris水迷宫评价不同时间段学习、记忆障碍程度,以及海马、皮质病理变化。结果 注射红藻氨酸大鼠出现颞叶癫痫发作,随发作时间延长出现不同程度学习、记忆障碍,定位航行实验示逃避潜伏期延长,空间搜索实验示原平台象限内游泳时问百分比下降,与对照组比较均有显著性差异（P〈0．05）,发作后2个月达到高峰。右侧海马锥体细胞逐渐出现变性、坏死,由CA3区向CA4、CA2、CA1区扩展,2个月达到高峰;对侧海马锥体细胞也出现变性、坏死。但程度明显低于注射侧。结论 大鼠颡叶癫痫发作后,其学习、记忆障碍程度与海马变性、坏死程度具有一定相关性。     

Human single-neuron responses at the threshold of conscious recognition

We studied the responses of single neurons in the human medial temporal lobe while subjects viewed familiar faces, animals, and landmarks. By progressively shortening the duration of stimulus presentation, coupled with backward masking, we show two striking properties of these neurons. (i) Their responses are not statistically different for the 33-ms, 66-ms, and 132-ms stimulus durations, and only for the 264-ms presentations there is a significantly higher firing. (ii) These responses follow conscious perception, as indicated by the subjects' recognition report. Remarkably, when recognized, a single snapshot as brief as 33 ms was sufficient to trigger strong single-unit responses far outlasting stimulus presentation. These results suggest that neurons in the medial temporal lobe can reflect conscious recognition by "all-or-none" responses.     

Adenosine receptor antagonists alter the stability of human epileptic GABAA receptors

We examined how the endogenous anticonvulsant adenosine might influence γ-aminobutyric acid type A (GABA_A) receptor stability and which adenosine receptors (ARs) were involved. Upon repetitive activation (GABA 500 μM), GABA_A receptors, microtransplanted into Xenopus oocytes from neurosurgically resected epileptic human nervous tissues, exhibited an obvious GABA_A-current (I_GABA) run-down, which was consistently and significantly reduced by treatment with the nonselective adenosine receptor antagonist CGS15943 (100 nM) or with adenosine deaminase (ADA) (1 units/ml), that inactivates adenosine. It was also found that selective antagonists of A2B (MRS1706, 10 nM) or A3 (MRS1334, 30 nM) receptors reduced I_GABA run-down, whereas treatment with the specific A1 receptor antagonist DPCPX (10 nM) was ineffective. The selective A2A receptor antagonist SCH58261 (10 nM) reduced or potentiated I_GABA run-down in ≈40% and ≈20% of tested oocytes, respectively. The ADA-resistant, AR agonist 2-chloroadenosine (2-CA) (10 μM) potentiated I_GABA run-down but only in ≈20% of tested oocytes. CGS15943 administration again decreased I_GABA run-down in patch-clamped neurons from either human or rat neocortex slices. I_GABA run-down in pyramidal neurons was equivalent in A1 receptor-deficient and wt neurons but much larger in neurons from A2A receptor-deficient mice, indicating that, in mouse cortex, GABA_A-receptor stability is tonically influenced by A2A but not by A1 receptors. I_GABA run-down from wt mice was not affected by 2-CA, suggesting maximal ARs activity by endogenous adenosine. Our findings strongly suggest that cortical A2–A3 receptors alter the stability of GABA_A receptors, which could offer therapeutic opportunities.     

Spatio-temporal heterogeneity in hippocampal metabolism in control and epilepsy conditions

The hippocampus’s dorsal and ventral parts are involved in different operative circuits, the functions of which vary in time during the night and day cycle. These functions are altered in epilepsy. Since energy production is tailored to function, we hypothesized that energy production would be space- and time-dependent in the hippocampus and that such an organizing principle would be modified in epilepsy. Using metabolic imaging and metabolite sensing ex vivo, we show that the ventral hippocampus favors aerobic glycolysis over oxidative phosphorylation as compared to the dorsal part in the morning in control mice. In the afternoon, aerobic glycolysis is decreased and oxidative phosphorylation increased. In the dorsal hippocampus, the metabolic activity varies less between these two times but is weaker than in the ventral. Thus, the energy metabolism is different along the dorsoventral axis and changes as a function of time in control mice. In an experimental model of epilepsy, we find a large alteration of such spatiotemporal organization. In addition to a general hypometabolic state, the dorsoventral difference disappears in the morning, when seizure probability is low. In the afternoon, when seizure probability is high, the aerobic glycolysis is enhanced in both parts, the increase being stronger in the ventral area. We suggest that energy metabolism is tailored to the functions performed by brain networks, which vary over time. In pathological conditions, the alterations of these general rules may contribute to network dysfunctions.

Energy production in brain cells is assumed to be optimized to perform tasks or activities in a brain region–specific manner (1–3). Simultaneously, neuronal activity should be adapted to minimize the energy expenditure required for its fueling (4, 5). Several metabolic pathways are available for energy production, in particular glycolysis and oxidative phosphorylation (1). Whether specific metabolic pathways are preferably recruited in different brain areas in a task-dependent manner is not known. The hippocampus is an ideal region to test this hypothesis. The dorsal hippocampus (DH) is involved in learning and memory associated with navigation, exploration, and locomotion, whereas the ventral hippocampus (VH) is involved in motivational and emotional behavior (6–8). These functions are supported by very distinct anatomical (9, 10), morphological (11–13), molecular (14–19), and electrophysiological (12, 13, 20–23) properties of hippocampal cells. The hippocampus structure is also highly heterogeneous at the gene level, from its dorsal to its ventral tip (24, 25), which may serve as a substrate for different functional networks related to cognition and emotion to emerge (7, 26, 27). Given the hippocampus’s heterogeneity, from structure to function, along its dorsoventral axis, our first hypothesis is that energy production is different between the VH and the DH.If energy production is tailored to a given structure–function relationship, we predicted that a change in energy production should accompany a change in the hippocampus’s functional state. Epilepsy is a particularly relevant situation to test this hypothesis. The different types of epilepsies are associated with numerous metabolic and bioenergetic alterations (28). Hypometabolism of epileptic regions is a common signature of mesial temporal lobe epilepsy (TLE) in humans and animal models, such as the pilocarpine model (29, 30). Importantly, in patients with TLE, only the temporal part (including the hippocampus) is epileptogenic. The temporal part corresponds to the ventral part in rodents, which has been identified as the epileptogenic region in the pilocarpine mode (31). Our second hypothesis is that any dorsoventral organization of energy metabolism found in control condition is altered in epilepsy.Finally, hippocampal functions demonstrate circadian regulation (32), in particular place cell properties (33) and long-term synaptic plasticity (34) as well as memory and learning processes (35, 36). Our third hypothesis is that energy production, specifically the respective contributions of oxidative phosphorylation and aerobic glycolysis (3), vary as a function of the time of the day in control and epilepsy.To test these three hypotheses, we used an ex vivo approach to evoke an energy-demanding electrophysiological activity standardized for the three independent variables considered here: time, region (DH/VH), and perturbation (control/epilepsy). As a first step toward a better understanding of the time regulation of hippocampal metabolism, we considered two time points during the night/day cycle: Zeitgeber 3 (ZT3) and Zeitgeber 8 (ZT8), as they correspond to low and high seizure probability in the TLE model used (37). We found that the control DH and VH have distinct time-dependent metabolic signatures regarding glycolysis and oxidative phosphorylation. In experimental epilepsy, there is no more dissociation between DH and VH at ZT3, but the regional difference reappears at ZT8.     

脑卒中后癫痫及其发作诊治的几点看法

癫痫发作作为脑卒中的首发症状或脑卒中后常见的并发症,其发生与发展可能会进一步影响脑卒中患者的预后。科学的处理脑卒中后癫痫发作对于脑卒中预后至关重要。关于卒中后癫痫发作和卒中后癫痫的大规模流行病学和高质量的临床研究依然有限,本文论述有关脑卒中后癫痫发作和脑卒中后癫痫的诊疗现状。     

Resting-state fMRI in temporal lobe epilepsy patients with cognitive impairment: A protocol for systematic review and meta-analysis

Background:Temporal lobe epilepsy is a group of neurological diseases caused by the repeated abnormal discharge of brain neurons. Patients with this disease are often accompanied with cognitive impairment. However, the pathogenesis of the cognitive impairment remains unclear. Resting state functional magnetic resonance imaging is a kind of magnetic resonance imaging method based on blood oxygen level dependence. This can reflect the spontaneous brain functional activity of a human brain in the resting state. In recent years, a number of researchers have used resting state functional magnetic resonance imaging to study the changes in resting spontaneous brain function in patients with temporal lobe epilepsy with cognitive impairment (TLE-CI). However, due to the differences in sample and methodology, the results of these studies were inconsistent. Therefore, the present study aimed to investigate the characteristics of the resting spontaneous brain function in patients with TLE-CI through a meta-analysis.Methods:A search was conducted on electronic databases, including PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure, WANGFANG DATA and Chinese Biomedical Literature Database, and Baidu scholar Database, from the establishment of the database to April 20, 2021. Randomized controlled trials that employed amplitude of low-frequency fluctuations/regional homogeneity to investigate the changes in resting spontaneous brain function in patients with TLE-CI were selected. Anisotropic effect size version of signed differential mapping was applied to perform the data analysis.Results:The study summarized the changes in spontaneous brain function in patients with TLE-CI.Conclusion:The conclusion for the functional cerebral alterations based on the latest studies will be provided.     

脑电图对癫痫自动症定位的诊断价值

目的分析癫痫自动症的临床和脑电图(EEG)特征,探讨EEG在癫痫自动症诊断中的意义。方法对46例癫痫自动症患者的临床、神经影像学和EEG进行分析。结果46例患者中,以口咽自动症多见(35／46例),其中以颞叶癫痫居多,言语自动症癫痫活动多起源于非优势半球,过度运动仅见于额叶癫痫;睡眠中或发作期额区起源特征性放电在额叶癫痫定位诊断中价值较高;对颞叶癫痫的诊断蝶骨电极价值较为可靠。结论自动症是多种类型癫痫发作所共有的特征．在其定位诊断中EEG有较高辅助诊断价值。