强直关节运动在局灶相关性癫痫患者双侧强直发作中的定侧意义研究

Lateralizing Value of Tonic Joint Movements in Bilateral Seizures of Focal Epilepsy

目的分析局灶相关性癫痫患者双侧肢体强直的非对称性特点及其侧向性定位诊断价值。方法选取2013年3月—2016年3月首都医科大学附属三博脑科医院癫痫中心住院并经过长程视频脑电图监测及综合评估的癫痫患者,分析其双侧肢体强直发作演变特点及时间相关性。将上肢分为远段(指/腕关节)、中段(肘关节)、近段(肩关节),依据强直关节运动的不同方向分为伸展运动和屈收运动,分别观察双侧肢体[致痫区(EZ)对侧、同侧]各节段强直关节运动—伸展和屈收,并依次记录双侧强直肢体不同节段出现的关节运动时间。结果 22例患者最终共74次双侧肢体强直发作。63次(85.1%)起始强直关节运动(ITMJ)位于EZ对侧,6次(8.1%)ITMJ位于EZ同侧,5次(6.8%)ITMJ不能判断起始侧别。59次(79.7%)ITMJ表现为伸展运动,10次(13.5%)表现为屈收运动,5次(6.8%)同时出现不同节段的伸展和屈收运动。EZ对侧肢体各节段强直发作中,中段(肘)强直关节运动时间为(14.2±13.1)s。结论局灶性癫痫双侧肢体强直发作的演变具有非对称性。首先出现关节运动的肢体常位于致痫区(EZ)对侧,具有较好的定侧意义。

Objective To evaluate localization-related epilepsy with bilateral extremities tonic seizures(BETS)in view of clinical semiology and to determine if the BETS-manifested asymmetric characteristics provide lateralizing values for seizure origin.Methods The evolution of BETS in epilepsy patients who recived long range video electroencephalogram monitoring and comprehensive assessment in Beijing Sanbo Brain Hospital,Capital Medical University were analyzed.The upper limbs were divided into distal segments(fingers/wrist joints),middle segments(elbow joints)and proximal segments(shoulder joints).They were divided into stretching and flexing exercises according to different directions of ankylosis.The movement and extension of the ankylosis of the bilateral limbs〔epileptogenic zone(EZ),contralateral side〕were observed,and the joint movement time of different segments of bilateral ankylosis was sequentially recorded.Results During the evolution of BETS,22 patients eventually had 74 bilateral twitch episodes.The rate of tonic movements of the joint that started from the contralateral extremities to the side of seizure was 85.1%(63/74),and the rate of initial tonic movements of the joint(ITMJ)that manifested as extension and abduction was 79.7%(59/74).With regard to ITMJ,6 cases(8.1%)localized to the same side of EZ,but the starting side could not be verified in 5 cases(6.8%).Ten cases(13.5%)of ITMJ showed flexion exercise and 5 cases(6.8%)showed different segments of stretch and flexion movements simultaneously.The motion time of the middle segment(elbow)ankylosis was(14.2±13.1)s during the ankylosis of each segment of the lateral limb of the EZ.Conclusion The evolution of BETS in focal epilepsy manifested as asymmetric characteristics in space.ITMJ may act as a lateralizing sign which increases the positive rate of lateralization.