Abstract：
Dissociation is a \"disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment\" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a \"dreamy state\". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one\'s own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
摘要：
分离是对意识通常综合功能的破坏，记忆,根据DSM-5，对环境的身份或感知。常见于精神疾病，包括原发性分离性疾病，创伤后应激障碍,抑郁症,和恐慌症。在物质中毒的背景下也描述了解离现象，睡眠剥夺和医疗疾病，包括创伤性脑损伤，偏头痛,和癫痫。与健康对照相比，癫痫患者在分离经历量表上测量的分离经历率更高。症状，尤其是颞叶起源的局灶性癫痫，可能包括像似曾相识/似曾相识的经历，去个性化,失去知觉，被描述为“梦幻状态”。这些描述在起源于内侧颞叶癫痫的癫痫发作中很常见，可能涉及杏仁核和海马。其他发作分离现象包括自动镜检查和体外体验，这被认为是由于负责整合自己的身体和额外的个人空间的网络中断，并涉及颞顶交界处和后脑岛。在这篇叙述性评论中，我们将总结有关癫痫分离经验的最新文献，以及功能性癫痫发作的分离经验。使用案例示例，我们将回顾分离症状的鉴别诊断。我们还将回顾不同诊断实体中分离症状的神经生物学基础，并讨论发作症状如何阐明复杂心理过程的神经生物学，包括意识和自我认同的主观性质。
