双侧强直发作的局灶相关性癫痫的电-临床症状学分析

Electroclinical semiology study on bilateral tonic seizures in localization related epilepsy

目的分析具有双侧强直发作的局灶相关性癫痫的电-临床症状学特点。方法分析发作期脑电图(EEG)、双侧肢体强直发作特点及可靠的伴随症状(正确预测率>80%)-偏转、单侧面肌强直、单侧阵挛、单侧肢体感觉异常、M2e、"4"字征。结果 24例患者81次发作,依据致痫区部位分为旁矢状面皮质癫痫组和外侧面皮质癫痫组。(1)81次发作中48次(59.3%)发作期头皮EEG具有侧向性征象,其中20次(24.7%)具有定位征象;(2)旁矢状面皮质癫痫组双侧强直出现时间为6.8s,外侧面皮质癫痫组为13s(P=0.031),双侧强直持续时间分别为13.1s和16.5s(P=0.078),前者差异具有显著性;(3)依据可靠的伴随症状,外侧面皮质癫痫组正确定侧率高于旁矢状面皮质癫痫组(72.5%vs 43.3%P=0.016),差异有统计学意义。结论局灶相关性癫痫双侧强直出现早、持续时间短特点,提示致痫区(EZ)位于或近辅助感觉运动区(SSMA)。

Objective To evaluate the localization-related epilepsy with bilateral extremities tonic seizures(BETS)based on electroclinical semiology.Method The ictal scalp electroencephalogram(EEG),clinical semiology of tonic seizures and the BETS's concomitant symptom with a robust lateralizing value(positive predictive value PPV>80%)were evaluated-version,unilateral grimacing,unilateral clonic seizure,unilateral somatosensory aura,M2e,figure 4 sign.Results A total of eighty-one seizures in twenty-four patients were included for analysis.According to the epileptogenic zone,the patients were divided into the parasagittal cortex epilepsy group(PCE)and the lateral cortex epilepsy group(LCE).①In forty-eight(59.3%)of the eighty-one seizures,the EEGs were considered to have lateralizing features,among which the localizable EEGs was 20(24.7%);②In PCE,onset of BETS occurred at a median onset time of 6.8 s versus13 s in LCE(P=0.031).The median duration of BETS was 13.1 s in PCE patients versus 16.5 in LCE patients(P=0.078).The former difference was statistically significant;③Based on BETS's concomitant symptom,the positive rate of lateralization in LCE was higher than(in)PCE obviously(72.5%vs 43.3%P=0.016).The difference was statistically significant.Conclusion In the localization relate epilepsy,the onset and duration of BETS are short which could localize a seizure focused or adjacent to SSMA.