epilepsiaEpilepsy and paroxysmal conditionsЭпилепсия и пароксизмальные состояния2077-83332311-4088IRBIS LLC10.17749/2077-8333/epi.par.con.2026.264epilepsia-1311Research ArticleCLINICAL LECTURESКЛИНИЧЕСКИЕ ЛЕКЦИИEarly provoking factors of epileptogenesis in mesial temporal lobe epilepsyРанние провоцирующие факторы эпилептогенеза при мезиальной височной эпилепсииhttps://orcid.org/0000-0003-2988-5706КотовА. С.KotovA. S.

Котов Алексей Сергеевич - д.м.н., доцент.

ул. Щепкина, д. 61/2, Москва 129110

Scopus Author ID 25926388600

Alexey S. Kotov - Dr. Sci. Med., Assoc. Prof.

61/2 Shchepkin Str., Moscow 129110

Scopus Author ID 25926388600

https://orcid.org/0000-0002-3291-7994ФирсовК. В.FirsovК. V.

Фирсов Константин Владимирович - к.м.н., к.пс.н.

ул. Щепкина, д. 61/2, Москва 129110

Konstantin V. Firsov - PhD.

61/2 Shchepkin Str., Moscow 129110

firsovkonst@yandex.ruГосударственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»РоссияMoscow Regional Research and Clinical InstituteRussian Federation2026250420261817281Copyright © Kotov A.S., Firsov К.V., 20262026Котов А.С., Фирсов К.В.Kotov A.S., Firsov К.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epilepsia.su/jour/article/view/1311

Mesial temporal lobe epilepsy (MTLE) is a severe form of focal epilepsy, often therapy-resistant, resulting from a long-term epileptogenesis. This clinical lecture examines the key early provoking factors of MTLE development: prolonged febrile seizures in childhood, neuroinfections, perinatal hypoxia, and traumatic brain injuries. The universal pathophysiological mechanisms triggered by these factors are analyzed in detail: excitotoxicity, neuroinflammation, blood-brain barrier disruption, aberrant neurogenesis, synaptic reorganization, and the central role of mammalian target of rapamycin (mTOR) signaling pathway hyperactivation. MTLE pathogenesis is explained from the perspective of the “dual/multiple hit” model, according to which the cumulative impact of several injuries leads to the depletion of the hippocampal compensatory capabilities and the formation of hippocampal sclerosis. The importance of comprehensive diagnosis, including detailed history collection, magnetic resonance imaging according to epileptology protocol, and the search for biomarkers is emphasized. Treatment prospects are related to shifting focus towards predictive and preventive therapy targeting key molecular pathways (pro-inflammatory cytokines, mTOR signaling), paving the way for personalized disease management.

Мезиальная височная эпилепсия (МВЭ) представляет собой тяжелую форму фокальной эпилепсии, часто резистентную к терапии, в основе которой лежит длительный процесс эпилептогенеза. В лекции рассмотрены ключевые ранние провоцирующие факторы развития МВЭ: длительные фебрильные судороги в детском возрасте, нейроинфекции, перинатальная гипоксия и черепно-мозговые травмы. Подробно проанализированы универсальные патофизиологические механизмы, запускаемые этими факторами: эксайтотоксичность, нейровоспаление, нарушение гематоэнцефалического барьера, аберрантный нейрогенез и синаптическая реорганизация, а также центральная роль гиперактивации сигнального пути мишени рапамицина млекопитающих (англ. mammalian target of rapamycin, mTOR). Патогенез МВЭ объясняется с позиций модели «двойного или многократного удара», согласно которой кумулятивное воздействие нескольких повреждений приводит к истощению компенсаторных возможностей гиппокампа и формированию гиппокампального склероза. Подчеркнута важность комплексной диагностики, включающей детальный анамнез, магнитно-резонансную томографию по эпилептологическому протоколу и поиск биомаркеров. Перспективы лечения связаны со смещением акцента на предиктивную и превентивную терапию, направленную на ключевые молекулярные мишени (провоспалительные цитокины, mTOR-сигналинг), что открывает путь к персонализированному управлению заболеванием.

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The authors declare that there are no conflicts of interest present.