肌张力障碍姿势对颞叶内侧癫痫致痫区的定侧价值

Lateralizing value of dystonic posturing in patients with mesial temporal lobe epilepsy

目的探讨复杂部分发作（CPS）中上肢肌张力障碍姿势（DP）在药物难治性颞叶内侧癫痫（MTLE）致痫区定侧中的应用价值。方法对北京协和医院1997-2011年间89例MTLE并行手术治疗及术后长期随诊（≥2年）的患者术前发作录像进行回顾性的分析，重点关注DP出现时间及其与致痫区的侧别关系。结果在89例MTLE患者共424次CPS中，有37例（41．6％）患者的共92次CPS中出现了DP。绝大多数（92％）DP出现在发作中期，而不是发作的首发表现。DP出现的对侧多提示为致痫区侧，其定侧致痫区的阳性预测值（PPV）为93．9％。结论在MTLE中，DP是一种可靠的定位体征，具有较高定侧致痫区价值。

Objective To explore the lateralizing value of dystonic posturing （DP） of upper limb in patients with refractory mesial temporal lobe epilepsy （MTLE）. Methods Presurgical videotypes of 89 patients staying seizure-free for at least 2 years after temporal lobectomy were retrospectively reviewed. Attention was paid to temporal correlation between occurrence of DP and seizure and the relationship of DP to side of epileptogenic zone （resected side）. Results DP was observed in 92 complex partial seizure （CPS） from 37 （41.6%）patients among 89 patients with a total of 424 CPS. DP was not an initial symptom in the course of CPS and its onset occurred mostly in the middle third of ictus. DP displayed a high positive predictive value of 93.9% for lateralizing a contralateral seizure onset. Conclusion DP is a reliable lateralizing sign in patients with MTLE.