癫痫过度运动发作的症状分析

A semiological analysis of hypermotor seizures in 8 surgical cases

目的 分析过度运动发作 (hypermotorseizure)的癫痫临床症状特征及手术预后。 方法 8例运动过度发作的患者 ,分析癫痫 37次发作期间的临床症状 ,临床发作的起始时间 ,癫痫病灶的位置 ,手术结果及病理结果。结果 过度运动发作动作包括 :撞头、上肢舞动、前后出拳动作、踢脚、肢体甩动、下肢蹬车动作、躯体翻滚、躯体晃震、骨盆前后甩动等反复激烈动作。癫痫发作中其他发作症状包括 :匝眼、扮鬼脸、紧握和抓挠、怪声、紧张姿势。过度运动发作在一次癫痫发作开始的 1～ 5 3秒 (平均 12 .2秒 )时出现 ,持续时间 1～ 4 0秒 (平均 18.6秒 )。癫痫灶位置 :内侧额叶 5例 ,外侧额叶 2例 ,外侧颞叶 1例。 8例中 ,7例术后癫痫发作消失。病理 :8例均为皮质发育异常。结论 过度运动发作的产生主要来源于躯体和近体关节的反复激烈运动 ,常与其他类型发作混合发作 ;额叶癫痫容易产生此类发作 ,尤其是额叶内侧起源癫痫 ;

Objective To analyze semiology of hypermotor seizure onset time,average duration of hypermotor seizure,other components before or after hypermotor seizure and surgical outcomes.Method 37 hypermotor seizures in 8 cases were analyzed.Each seizure event was divided into hypermotor seizure component and other component.The semiology in the two components was examined.Onset time and duration of hypermotor seizure were calculated.Result Repetitive violent motor symptom as knocking head,swinging upper limbs,kicking,slapping,pedaling lower limbs,shaking,thrashing,rotating trunk,were categorized as hypermotor components.Other motor symptoms such as eye opening,blinking,grimacing,hand rubbing and grasping,dystonic posturing,motor arrest and bizarre vocalization were also observed,but these symptoms did not belong to hypermotor seizures but other types of seizures.Hypermotor seizures appeared from 1 to 53 s(mean 12.2 s) after the onset of other motor symptoms and last 1 to 40 s (mean 18.6 s).Seizure onsets were 5 cases in mesial frontal lobe,1 in triangular of inferior frontal gyrus,1 in operculum of inferior frontal gyrus, and 1 in superior temporal gyrus.After operations,7 cases were seizure free and 1 case had seizure reduction.Pathology confirmed focal cortical dysplsia in all cases. Conclusion Hypermotor seizure is characterized as repetitive and violent motor manifestations,mainly involving proximal joints and trunk.It always occurs with other seizure type.Frontal seizure onset is prone to develop such kind of seizure.The outcomes of operations are encouraging.