《Seizure》杂志主编推荐：癫痫意外死亡的神经-心脏-呼吸联系

        为了让大家更快地了解前沿资讯，我们今年起与《Seizure》杂志(https://www.seizure-journal.com)合作，定期推出一些重要文章。文章由《Seizure》杂志主编Markus Reuber推荐，并介绍主要内容要点。读者同时可通过相关链接免费得到原文。(https://doi.org/10.1016/j.seizure.2018.12.007)

        本期介绍的文章有关癫痫意外死亡。长期以来，癫痫相关的皮质下、脑干改变研究甚少，有关植物神经系统的参与亦不清楚。该文主要描述了植物神经系统在癫痫中的作用，包括对控制心跳、血压、呼吸的脑网络系统的影响。这些都与癫痫意外死亡有关。近年有研究显示浴缸中死亡的病人并没有溺水致死的相关病理学证据。有关研究将有助于明确癫痫意外死亡的机理，预防和减少这种常见危害年青癫痫病人生命的现象。

Seizure 2018, Vol 64, Editor’s Choice: “Sudden Unexplained Death in Epilepsy: The Neuro-Cardio-Respiratory Connection”

Many still think of epilepsy as a disorder characterised by abnormal discharges in cortical neurons. Despite steadily accumulating evidence, the involvement of subcortical and brain stem structures in ictal physiological changes (and their interictal consequences) is still not widely appreciated. In the cortical interpretation of epilepsy, the autonomic nervous system is a phylogenetically ancient feature of the brain, which largely operates on “autopilot” and is quite separate from the parts and networks of the brain that are of interest to epileptologists. However, this understanding of epilepsy cannot really be upheld. For instance, recent studies have shown ictal effects on serotonergic pathways in the brainstem closely involved in respiratory control (1). Recurrent seizures may lead to persistent changes of interictal functioning of the ascending reticular activating system in the brainstem (2).

My Editor’s Choice selection from the current issue of Seizure, a narrative review by T. A. Manolis et al., demonstrates that the involvement of the autonomic nervous system in epileptic seizures is not just of interest to neuroanatomists or physiologists (3).  The close links between ictal cortical discharges and brain networks involved in the control of heart rate, blood pressure and breathing are likely to be highly relevant in the aetiology of Sudden Unexpected Death in Epilepsy (SUDEP). For some time SUDEP has been acknowledged as the commonest cause of death in younger adults with epilepsy (4). Recent evidence demonstrating the absence of any post-mortem signs of drowning in many individuals with epilepsy who died in the bath, suggests that SUDEP may be an even commoner cause of death than once thought (5). The comprehensive overview of the seizure-related changes in the brain which affect the functioning of the autonomic nervous system should help to correct the “corticocentric” view of epilepsy and demonstrates that a wider understanding of this disorder will be needed if we want to stop more people from dying in the context of epileptic seizures in the future.

1.Zhan Q, Buchanan GF, Motelow JE, Andrews J, Vitkovskiy P, Chen WC, Serout F, Gummadavelli A, Kundishora A, Furman M, Li W, Bo X, Richerson GB, Blumenfeld H. Impaired Serotonergic Brainstem Function During and After Seizures. J Neurosci 2016;36:2711–2722.

2.Englot DJ, Gonzalez HFJ, Reynolds BB, Konrad, Jacobs ML, Gore JC, Landman BA, Morgan VL. Relating structural and functional brainstem connectivity to disease measures in epilepsy. Neurology 2018; 91: 2018 Jul 3;91(1):e67-e77.

3.Manolis TA, Manolis AA, Melita H, Manolis AS. Sudden Unexpected Death in Epilepsy: The Neuro-Cardio-Respiratory Connection. Seizure 2019 – PLEASE ADD BIBLIOGRAPHIC DETAILS

4.Devinsky O, Hesdorffer DC, Thurman DJ, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol 2016;15:1075-88.

5.Cihan E, Hesdorffer DC, Brandsoy M, Li L, Fowler DR, Graham JK, Donner EJ, Devinsky O, Friedman D. Dead in the water: Epilepsy-related drowning or sudden unexpected death in epilepsy? Epilepsia 2018;59:1966-72.