What causes seizures, and how can we treat them? - Christopher E. Gaw

譯者: Camila Lin 審譯者: Amanda Zhu

Nearly three millennia ago,

在三千多年前的一塊巴比倫石板上，

a Babylonian tablet described a curious illness called miqtu.

記載著一種叫 「miqtu」的稀奇疾病。

Said to cause symptoms ranging from facial twitching to full body convulsions,

據說這種疾病會引起抽搐， 從單一部位的臉部到全身都有。

the Babylonians believed those afflicted were possessed by evil spirits,

巴比倫人認為受此病折磨的人， 是被惡靈附身。

and the only treatment was divine intervention.

唯一的解方，就是神聖力量的干涉。

Today, we know the symptoms of miqtu by another name,

今天，我們給了 「miqtu」另一個名字，

and modern medicine has developed numerous treatments

現代醫學也發展出許多治療方法，

for those experiencing seizures.

來幫助那些罹患癲癇的人。

But these ancient afflictions still hold a surprising number of secrets.

但在這歷史悠久的病症背後， 還有為數驚人的秘密等待發掘。

Doctors define a seizure as any set of symptoms

醫生們對癲癇的定義是，

由過度的腦電活動 所導致的各種症狀組合。

resulting from excess electrical activity in the brain.

Outside this shared feature, there is a massive range of seizure symptoms,

除此共同特徵，癲癇的症狀範圍甚大；

研究者已發現多種類型的癲癇症狀。

and researchers have identified a variety of different seizure types.

［突然跌倒、大叫、凝視、先兆、

咂嘴、僵硬、抽搐、眨眼、搓手、 大小便失禁、嘴巴抽搐、喪失意識］

But regardless of the underlying conditions that cause them,

但撇除導致癲癇的潛在疾病不談，

［癲癇症候群］

every seizure begins here.

每一次的癲癇發作都從這裡開始。

Hippocrates identified the brain as the source of seizures around 400 BCE.

大約西元四百年前，希波克拉底發現 大腦是導致癲癇的原因。

However, this insight didn't immediately lead to better treatments.

但是，這份見解並沒有 立即帶來更好的治療方法。

Generally, ancient Greeks prescribed medicinal herbs and alterations in diet.

一般而言，古希臘人會囑咐病人 食用藥用植物與替代飲食，

If they believed the seizure was caused by bleeding in the skull,

但如果他們相信， 顱內出血是導致癲癇的原因，

they sometimes employed a technique called trepanation.

有時也會使用一種叫 「頭部穿孔」的技術。

This early surgery involved drilling a hole in the skull to let blood escape

這種早期的手術會在頭骨上鑽個洞，

以便引出積血，同時減輕腦壓。

and relieve pressure on the brain.

Trepanation had... sizable risks.

雖然頭部穿孔的風險相當大，

But it wasn’t until the 19th century that scientists would make

但仍要等到十九世紀，

科學家才會在癲癇治療上， 往前跨一大步。

the next leap forward in seizure treatment.

In 1870, two German researchers discovered that using electricity

在 1870 年，兩個德國研究者發現，

使用電擊來刺激狗大腦的特定部分， 就能讓牠的某些身體部位移動。

to stimulate specific areas of a dog’s brain could move parts of its body.

Around the same time, other scientists discovered the brain and nervous system

差不多在同一時間， 其他科學家發現了

were connected via a network of cells called neurons

叫做「神經元」的細胞網路， 連結了大腦與神經系統，

that transmitted electrical signals throughout the body.

並將訊號傳送到全身。

This established the brain as the control center for nerve impulses

這個發現證實了大腦 是控制神經衝動的中樞。

that determine our thoughts and movement.

而神經衝動決定了思考與身體的運動。

Better yet, this model made it clear that seizures were due to errors

更棒的是，這個模型讓我們清楚了解，

癲癇是因為神經控制中心出了錯

in that control center,

such as misfiring neurons or excess electrical activity.

──像是神經元異常放電 或過度腦電活動──

才導致癲癇發作。

Early experiments even suggested that different patterns of misfiring

早期的研究也顯示， 不同的神經元放電模式

could account for different seizure types and symptoms.

是有各種不同癲癇類型及症狀的原因。

So if seizures were due to neurons misfiring,

所以，如果癲癇是 神經元異常放電導致的，

how could doctors stop this from happening?

醫生又該如何阻止癲癇發作？

Physicians like Sir Charles Locock hypothesized that sedative drugs

查理斯‧羅庫克爵士等 早期的醫生提出假說，

表示鎮靜劑能鎮靜過度活躍的大腦，

might calm overactive brain activity,

a theory he confirmed by treating seizures

而爵士本人則以溴化鉀治療癲癇，

with a medication called potassium bromide.

驗證了這個假設。

Others like Sir Victor Horsley

維克多‧霍斯利爵士等人則認為，

suspected that removing damaged parts of the brain might stop a patient's seizures.

切除腦中受損的部位， 也許就能阻止癲癇發作。

In 1886, he performed a craniotomy,

在 1886 年，霍斯利爵士 進行一場開顱手術，

temporarily removing part of a patient's skull to extract scarred brain tissue.

暫時切下病患的一部分頭骨， 以便取出腦疤痕組織。

Not only did his patient survive, but his seizures improved,

他的病患不僅成功存活， 癲癇症狀也有所改善，

launching further research in surgical treatments.

為癲癇外科治療開展進一步的研究。

Over the next two centuries, seizure treatments advanced rapidly.

在其後的兩百年內， 癲癇治療有飛躍性的進展。

And today, there are dozens of available seizure medications

現在，我們已有許多可用的癲癇藥物，

that work with unprecedented specificity.

它們具有前所未見的專一性功效。

Some newer medications are able to focus on specific proteins

某些新藥能針對 神經元內的特定蛋白質，

in the neuron to help manage electrical activity.

以控制腦電活動。

And advanced brain imaging techniques can sometimes allow doctors to pinpoint

先進的大腦影像技術，

有時也能讓醫生看出， 究竟是哪個部位引起癲癇。

exactly what parts of the brain are causing an individual's seizures.

Surgeons then use this information to perform targeted surgeries.

外科醫生就能根據這些資訊， 針對特定部位進行手術。

These various treatments help doctors manage the majority of seizure cases,

有了這麼多種療法，足以讓醫生們 處理大多數的癲癇案例，

allowing most people with seizures to live healthy and comfortable lives.

讓大多數的癲癇患者 都能擁有健康舒適的生活。

But the underlying pathology of many seizures remains elusive.

但許多種癲癇的潛在病理 仍然難以捉摸。

In cases without clear brain damage or certain types of pre-existing conditions,

以沒有明顯腦傷或預先 沒有其他疾病的案例而言，

it's incredibly difficult to determine what causes neurons to misfire.

釐清神經元異常放電的原因十分困難。

It's also not always clear why some treatments are effective.

我們也無法總是清楚 為何某些療法特別有效。

And even more mysterious are cases where seizures are resistant

更神祕的是，現存的療法 對某些病例不起作用，

to existing treatments that work on similar seizure types.

但對相似的癲癇類型療效甚佳。

Scientists are still working on these questions,

科學家還在找尋這些問題的解答，

but there are clear answers for what to do

但如果你遇到一個癲癇發作的人，

if you encounter someone experiencing a seizure.

該怎麼幫忙他，早已有正確解答。

You should never hold a seizing person down,

你絕對不可以壓制癲癇發作的人、

put objects in their mouth, or perform CPR.

把東西塞進他們的嘴巴， 或是幫他們做心肺復甦術。

Instead, try to keep the person safe from falling or bumping their head,

相反地，你該試著保護他們的安全， 預防他們跌倒或是撞到頭，

shift them onto their side to keep airways open,

讓他們側躺，保持呼吸道順暢，

and stay with them until medical help arrives.

陪在他們身邊， 等專業醫療人員抵達。