颞叶癫痫合并额叶运动症状对癫痫严重程度及预后的影响

Influence of temporal lobe epilepsy patients with frontal lobe motor symptoms on the severity and prognosis of epilepsy

目的探讨颞叶癫痫(temporal lobe epilepsy,TLE)患者出现额叶运动症状与癫痫严重程度的关系,分析合并额叶运动症状对癫痫患者药物治疗预后的影响。方法选择2018年4月至2019年12月在复旦大学附属中山医院神经内科就诊的151例TLE患者,进行16 h连续长程视频脑电监测。根据是否合并额叶运动症状分为合并组(TLE/F+组,n=42)和未合并组(TLE/F−组,n=109)。比较2组患者的癫痫发作症状、VA-2癫痫严重程度量表评分、MMSE简易智力状态量表评分等。采用多因素回归分析影响TLE严重程度的危险因素。对患者进行1年的随访,比较2组患者药物难治性癫痫(drug-resistant epilepsy,DRE)的发生率。结果TLE合并额叶运动症状的发生率为27.81%。与TLE/F−组相比,TLE/F+组的癫痫发作频率更高(P=0.002)、VA-2评分更高(P=0.002)、抗癫痫药物使用率(83.33%vs 64.22%,P=0.029)及多药联合使用率(38.10%vs 22.02%,P=0.036)更高。多因素分析结果显示,头眼向对侧偏转是癫痫发作频率增加(OR=8.246,P=0.004)、VA-2评分升高(β=0.277,P<0.001)的共同危险因素,过度运动(β=0.343,P=0.003)是VA-2评分升高的危险因素。随访1年后TLE/F+组诊断DRE的比例更高(50%vs 15%,P<0.001)。结论TLE合并额叶运动症状与癫痫严重程度相关,也是TLE患者药物治疗预后不良的影响因素,在临床诊疗中应早期识别此类患者并给予积极干预。

Objective To explore the effect of combined frontal lobe motor symptoms on the severity and prognosis of drug therapy in patients with temporal lobe epilepsy(TLE). Methods From April 2018 to December 2019, 151 patients with TLE were collected in the Department of Neurology, Zhongshan Hospital, Fudan University. All the patients received 16-hour continuous long-range video EEG monitoring. Patients were divided into combined frontal lobe motor symptoms group(TLE/F+,n=42) and non-combined frontal lobe motor symptoms group(TLE/F-, n=109). Epileptic symptoms, VA-2 epileptic severity score and MMSE score were compared between the two groups. Multivariate regression analysis was used to flnd risk factors of epilepsy severity. Patients were followed up for one year, and the incidence of drug-resistant epilepsy(DRE) was compared between the two groups. Results The incidence of TLE with frontal lobe motor symptoms was 27.81%. Compared with TLE/F-group, patients in TLE/F+ group had higher seizure frequency(P=0.002), higher VA-2 score(P=0.002), higher antiepileptic drug use rate(83.33%vs 64.22%, P=0.029) and higher multi-drug combination rate(38.10% vs 22.02%, P=0.036). Multivariate analysis showed that the contralateral deflection of the head and eyes was a common risk factor for the increased attack frequency(OR=8.246, P=0.004)and increased VA-2 score(β=0.277, P<0.001), and excessive movement(β=0.343, P=0.003) was the risk factor of increased VA-2score. After one year’s follow-up, patients in TLE/F+ group had a higher rate of DRE than those in TLE/F-group(50.0% vs 15.0%,P<0.001). Conclusion TLE combined with frontal lobe motor symptoms is related to the increased seizure severity, and it is also a negative factor for the prognosis of TLE patients with drug therapy. In clinical diagnosis and treatment, such patients should be diagnosed and treated early.