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Basic Mechanisms of Epileptogenesis in Pediatric Cortical Dysplasia

机译:小儿皮质发育异常的癫痫发生的基本机制

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Summary Cortical dysplasia (CD) is a neurodevelopmental disorder due to aberrant cell proliferation and differentiation. Advances in neuroimaging have proven effective in early identification of the more severe lesions and timely surgical removal to treat epilepsy. However, the exact mechanisms of epileptogenesis are not well understood. This review examines possible mechanisms based on anatomical and electrophysiological studies. CD can be classified as CD type I consisting of architectural abnormalities, CD type II with the presence of dysmorphic cytomegalic neurons and balloon cells, and CD type III which occurs in association with other pathologies. Use of freshly resected brain tissue has allowed a better understanding of basic mechanisms of epileptogenesis and has delineated the role of abnormal cells and synaptic activity. In CD type II, it was demonstrated that balloon cells do not initiate epileptic activity, whereas dysmorphic cytomegalic and immature neurons play an important role in generation and propagation of epileptic discharges. An unexpected finding in pediatric CD was that GABA synaptic activity is not reduced, and in fact, it may facilitate the occurrence of epileptic activity. This could be because neuronal circuits display morphological and functional signs of dysmaturity. In consequence, drugs that increase GABA function may prove ineffective in pediatric CD. In contrast, drugs that counteract depolarizing actions of GABA or drugs that inhibit the mammalian target of rapamycin ( mTOR ) pathway could be more effective.
机译:总结皮质发育不良(CD)是由于细胞异常增殖和分化引起的神经发育障碍。神经影像学的进步已被证明可以有效地及早发现较严重的病变,并及时进行手术切除以治疗癫痫。但是,癫痫发生的确切机制尚不完全清楚。这篇综述基于解剖学和电生理学研究,探讨了可能的机制。 CD可归类为由结构异常组成的CD型I,伴有畸形的巨细胞神经元和球囊细胞存在的CD型II和与其他病理相关的CD型III。使用新鲜切除的脑组织可以更好地了解癫痫发生的基本机制,并描述了异常细胞和突触活动的作用。在II型CD中,已证明气囊细胞不会启动癫痫活动,而畸形的巨细胞和未成熟神经元在癫痫放电的产生和传播中起重要作用。小儿CD的意外发现是GABA突触活性并未降低,实际上,它可能促进癫痫活性的发生。这可能是因为神经元回路显示了不成熟的形态和功能体征。因此,增加GABA功能的药物可能在小儿CD中无效。相反,抵消GABA的去极化作用的药物或抑制哺乳动物雷帕霉素靶标(mTOR)的药物可能更有效。

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