发作期碰触面部动作在颞叶癫痫致痫区定侧中的意义

Lateralizing value of ictal face wiping in patients with mesial temporal lobe epilepsy

目的探讨复杂部分发作（ CPS）发作期上肢碰触面部动作（ FW）在药物难治性颞叶内侧癫痫（ MTLE）致痫区定侧中的应用价值。方法对我院1997—2012年间96例行手术治疗及术后长期随诊（≥3年）的MTLE患者术前发作录像进行回顾性分析，重点关注发作期FW的发生率、出现时段及其与致痫区的侧别关系。结果在96例MTLE患者共523次CPS中，有21例（21.9％）患者的共44次（8.4％） CPS中出现了60次FW。绝大多数（55／60，91％）发作期FW部位限于口鼻区。多数FW（51／60，85％）出现在发作期中后时段。 FW出现侧多为致痫区侧，其定侧致痫区的阳性预测值为16／18。结论上肢FW在MTLE CPS中发生率较低且多出现在发作期后半段。与发作后FW类似，发作期FW完成侧多提示为致痫区侧，可作为定侧致痫区的可靠体征。

Objective To investigate the lateralizing value of ictal face wiping （ FW） in patients with refractory mesial temporal lobe epilepsy （ MTLE ） .Methods Presurgical video types were retrospectively reviewed among 96 patients who were seizure-free for at least 3 years after temporal lobectomy between 1997 and 2012.Attention was paid to the incidence and time of FW , and the relationship of FW to the side of epileptogenic zone （resected side）.Results Finally, 96 patients had total 523 complex partial seizure （CPS）, among whom FW was observed in 44 （8.4%） CPS from 21 （21.9%） patients.Nose and mouth were the most （55/60, 91%） touched area during FW, while most （51/60, 85%） ictal FW occurred in the later part of CPS.FW showed high positive predictive value of 16/18 for lateralization of an ipisilateral seizure onset.Conclusion Ictal FW represents a reliable lateralizing sign similar to postictal FW in patients with MTLE.