经SEEG证实以过度运动为发作症状的颞叶癫痫分析

Clinical analysis on patients with stereotactic electroencephalography proved hypermotor seizures originating from temporal lobe

目的探讨以过度运动为主要发作症状的颞叶癫痫患者的临床与电生理特点。方法回顾性分析广东三九脑科医院经立体定向脑电图(SEEG)证实的,以过度运动为主要发作症状的10例颞叶癫痫患者的临床资料;分析其症状学及脑电图特点。结果本组患者中,以颞叶内侧结构起始的患者7例,以颞叶新皮层起始的患者2例,以颞叶内外侧同步起始的患者1例。其中9例患者有发作前兆;所有患者均在过度运动发作的同时,伴有不同程度的自动运动(轻微的咂嘴、抿嘴、嘟嘴、手的摸索)和发作起始对侧肢体的肌张力障碍。SEEG均以周期性节律性棘-慢波→低波幅快活动为发作起始图形;脑电图起始至出现过度运动或自动运动的时间平均为65 s。结论以过度运动为主要发作症状的颞叶癫痫,其致痫区可以是颞叶内侧结构或颞叶新皮层。以过度运动为主要发作症状学,伴先兆、自动运动和对侧肢体的肌张力障碍,提示为颞叶起源的癫痫;先兆和自动症是颞叶癫痫与额叶癫痫鉴别的要点,可与额叶癫痫相鉴别。颞叶癫痫出现过度运动可能是同时或先后激活了额叶的腹内侧网络和颞岛网络所致。

Objective To explore the characteristics of clinical manifestations in patients with hypermotor epilepsy originating from the temporal lobe.Method The clinical data of 10 patients with epilepsy originating from the temporal lobe due to hypermotor proved by stereotactic electroencephalography(SEEG)were analyzed retrospectively.The symptomatology and EEG data of these patients were also analyzed.Results 7 of 10 patients'seizures originated from the medial temporal structure,2 from temporal neocortical,and one from medial and neocortical area at the same time.9 of the 10 patients have aura.All patients exhibited automotor(oral,close mouth,pouting and fumble)and dystonia of the upper limb or contralateral limb.Seizure onset pattern was preictal spiking followed by low-voltage fast activity.The duration from EEG onset to hypermotor or automotor was average 65 seconds.Conclusions The epileptogenic zone of temporal lobe origin induced by hypermotor may locate the medial temporal structure or temporal neocortical area.The semiology of temporal lobe epilepsy induced by hypermotor often accompanies by automotor and dystonia of the upper limb or contralateral limbs,which can be differentiated from frontal epilepsy.The hypermotor of temporal lobe may activate the ventromedial and temporal island networks of frontal lobe at the same time or successively.