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痫性发作和癫痫的病理生理学

Authors
Carl E Stafstrom, MD, PhD
Jong M Rho, MD
Section Editor
Timothy A Pedley, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
杨赟, 副主任医师

引言

痫性发作是指由神经元异常放电所致的神经功能障碍发作，临床表现为运动控制、感知觉、行为或自主神经功能改变。癫痫是由脑内异常电活动所致的反复自发性痫性发作病症。虽然在一定的病理生理条件下，任何人均可能出现痫性发作，但癫痫意指一种持续的颅脑功能改变，容易导致反复的痫性发作。癫痫形成是正常大脑变得易感癫痫的过程[1]。

在细胞水平，促进神经元过度兴奋性和神经元高度同步性的生化过程导致了癫痫的异常电活动基础。然而，单个神经元异常放电并不足以产生一次临床痫性发作，只有在大量神经元网络异常放电的情况下才会出现痫性发作。一些关键的皮质和皮质下结构参与了痫性发作的产生。

本专题将总结部分性和全面性癫痫发作活动的细胞基础，尤其是离子通道(产生神经元兴奋性的基本电流通道)和海马(脑部最易出现痫性发作的部位之一)进行专门讨论。抗癫痫药物的药理学以及关于癫痫患者评估和治疗的内容将单独讨论。 (参见“抗癫痫发作药物的作用机制、药理作用及不良反应”和“成人癫痫处理概述”)

痫性发作的分类

癫痫不是一种单一性疾病，而是有不同的临床表现、基础病因和病理生理学的混合体(表 1)。因此，具体痫性发作类型的发病机制和通路可能有所差异。依据起源部位和扩散方式可对痫性发作进行粗略分类(图 1)。

●部分性发作起源于大脑的局部区域，并且临床表现能够提示受累的脑部区域。病灶放电可局限在该区域，也可播散至邻近的皮质区域、皮质下结构和/或通过连合通路扩散至整个大脑皮质，后者被称为部分性癫痫继发全面性发作。例如，起源于左侧运动皮质的痫性发作可能引起右上肢抽动。如果癫痫样放电扩散至邻近区域并随后累及整个脑部，则被称为继发性全面强直-阵挛发作。

                 

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Literature review current through: 2017-07 . | This topic last updated: 2015-10-26.
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