Physiopathogenetic Interrelationship between Nocturnal Frontal Lobe Epilepsy and NREM Arousal Parasomnias.

Epilepsy research and treatment Pub Date : 2012-01-01 Epub Date: 2012-05-10 DOI:10.1155/2012/312693
Péter Halász, Anna Kelemen, Anna Szűcs
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引用次数: 34

Abstract

Aims. To build up a coherent shared pathophysiology of NFLE and AP and discuss the underlying functional network. Methods. Reviewing relevant published data we point out common features in semiology of events, relations to macro- and microstructural dynamism of NREM sleep, to cholinergic arousal mechanism and genetic aspects. Results. We propose that pathological arousals accompanied by confused behavior with autonomic signs and/or hypermotor automatisms are expressions of the frontal cholinergic arousal function of different degree, during the condition of depressed cognition by frontodorsal functional loss in NREM sleep. This may happen either if the frontal cortical Ach receptors are mutated in ADNFLE (and probably also in genetically not proved nonlesional cases as well), or without epileptic disorder, in AP, assuming gain in receptor functions in both conditions. This hypothesis incorporates the previous "liberation theory" of Tassinari and the "state dissociation hypothesis" of Bassetti and Terzaghi). We propose that NFLE and IGE represent epileptic disorders of the two antagonistic twin systems in the frontal lobe. NFLE is the epileptic facilitation of the ergotropic frontal arousal system whereas absence epilepsy is the epileptic facilitation of burst-firing working mode of the spindle and delta producing frontal thalamocortical throphotropic sleep system. Significance. The proposed physiopathogenesis conceptualize epilepsies in physiologically meaningful networks.

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夜间额叶癫痫与NREM觉醒异睡眠的生理病理关系。
目标建立NFLE和AP的病理生理机制,并探讨其潜在的功能网络。方法。回顾已发表的相关资料,指出了事件符号学的共同特征、与非快速眼动睡眠宏观和微观结构动态的关系、与胆碱能唤醒机制和遗传方面的关系。结果。我们认为,在非快速眼动睡眠额背侧功能丧失导致认知抑郁的情况下,伴有自主神经信号混淆行为和/或过度运动自动性的病理性觉醒是额叶胆碱能觉醒功能不同程度的表现。如果ADNFLE患者的额叶皮质乙酰胆碱受体发生突变(也可能在基因未证实的非病变病例中发生),或AP患者没有癫痫性疾病,则可能发生这种情况,假设两种情况下受体功能都有所增加。这一假说融合了之前塔西纳里的“解放论”和巴塞蒂和特扎吉的“状态分离假说”)。我们认为NFLE和IGE代表了额叶中两个拮抗双系统的癫痫性疾病。非功能性癫痫是脑额叶嗜角性觉醒系统的癫痫性促进,而癫痫缺失是脑额叶丘脑皮质嗜角性睡眠系统的梭形波和三角洲产生的突发工作模式的癫痫性促进。的意义。提出的生理病理机制概念化癫痫在生理上有意义的网络。
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