癫癎患者先兆症状的研究

Clinical study of epileptic aura

目的探讨癫癎患者先兆症状的发生比例、临床表现，为正确诊断治疗癫癎提供依据。方法回顾性研究1028例癫癎患者的临床资料，分析癫癎患者的先兆发生率、临床表现、脑电图和神经影像学结果。比较伴或不伴先兆的部分性发作癫癎患者的发病年龄、性别、脑电图、神经影像学的差异以及腹部先兆在颞叶内外侧癫癎出现比例的差异。结果部分性癫癎725例，484例（66．8％）出现先兆；全面性发作者303例，无一例患者出现先兆。64例患者出现2种或2种以上的先兆表现；14例出现持续性先兆的癫癎患者。1028例患者中脑电图异常547例（53．2％），影像学异常217例（21．1％）。484例有先兆症状的患者中286例脑电图异常（59．1％），126例（26．0％）影像学异常。伴或不伴先兆的部分性发作癫癎患者的首次发病年龄差异无统计学意义，腹部先兆在颞叶内外侧癫癎出现的比例差异有统计学意义（χ^2=170．877，P〈0．01）。结论癫癎患者先兆症状多样，分析先兆症状对于癫癎分型、病灶定位以及合理治疗有指导意义。

Objective To study the prevalence and clinical features of auras in epilepsy patients, and to evaluate the diagnosis criteria of epileptic auras. Methods All 1028 patients with epilepsy who were treated in the First Hospital of Peking University from January 2007 to January 2008 were enrolled in this retrospective study. Seizure types were diagnosed in accordance with the seizure classification scheme proposed by the International League Against Epilepsy （1981）. We studied the incidence rate, clinical features and presentations of electroencephalogram （EEG） and neuroimaging of epileptic auras. Student t-test was used to assess the statistic difference of the onset age of partial seizure in patients with and without auras. The chi-square test was used to statistically analyze the EEG and neuroimaging results in patients with partial seizure and the occurrence percentages of abdominal aura in lateral temporal lobe epilepsy （LTLE）and mesial temporal lobe epilepsy （MTLE）. Results Four hundred and eighty-four patients （66. 8% of 725 patients ） with partial seizures reported epileptic auras. None of the 303 patients with generalized seizures reported auras. Sixty-four patients experienced two or more types of auras. Fourteen patients had aura status. Of all enrolled patients, 53.2% and 21.1% showed abnormal EEG and neuroimaging,respectively. Of 484 partial epileptic patients with auras, 59. 1% and 26. 0% presented abnormal EEG and neuroimagings, respectively. The percentage of abdomen aura in patients with MTLE was significantly higher than those with LTLE （χ^2 = 170. 877, P 〈 0.01 ）. Conclusion Analysis of auras may help in classifying and localizing epilepsy and also in planning treatment.