Thomas P, Zifkin B, Migneco O, Lebrun C, Darcourt J, Andermann F
Service de Neurologie, Hôpital Pasteur, Nice, France.
Neurology. 1999 Apr 12;52(6):1174-83. doi: 10.1212/wnl.52.6.1174.
To determine the electroclinical characteristics and causative factors of nonconvulsive status epilepticus (NCSE) of frontal origin.
The authors conducted a 5-year prospective study.
Ten patients were studied (seven men, three women; mean age, 56.4 years). Six patients did not have previous epilepsy. The mean diagnostic delay was 48 hours (range, 3 to 96 hours). Two types of frontal NCSE were identified. In type 1 (n = 7), mood disturbances with affective disinhibition or affective indifference were associated with subtle impairment of cognitive functions without overt confusion. EEG showed a unilateral frontal ictal pattern and normal background activity. In type 2 (n = 3), impaired consciousness was associated with bilateral, asymmetric frontal EEG discharges occurring on an abnormal background. Ictal and postictal 99mTc hexamethyl propylene amine oxime (HMPAO) SPECT was performed in five patients and showed unilateral or bilateral frontal HMPAO uptake that aided localization, especially in type 2 NCSE of frontal origin. Etiologies included a focal frontal lesion in six patients (three of which were tumors), neurosyphilis, and nonketotic hyperglycemia. Eight patients did not respond to initial IV benzodiazepine (BZ), but IV phenytoin controlled six patients successfully. The immediate outcome was favorable in all patients. There was no long-term recurrence of SE in seven patients.
NCSE of frontal origin is a heterogeneous syndrome. Some cases are best described as simple partial NCSE, others as complex partial SE, and there are forms that overlap with absence SE. Emergency EEG and neuropsychological assessment are diagnostic, and SPECT may be useful. Many patients may not respond to IV BZ.
确定额叶起源的非惊厥性癫痫持续状态（NCSE）的电临床特征及病因。
作者进行了一项为期5年的前瞻性研究。
共研究了10例患者（7例男性，3例女性；平均年龄56.4岁）。6例患者既往无癫痫病史。平均诊断延迟时间为48小时（范围3至96小时）。确定了两种类型的额叶NCSE。在1型（n = 7）中，伴有情感脱抑制或情感淡漠的情绪障碍与认知功能的轻微损害相关，无明显意识模糊。脑电图显示单侧额叶发作期图形及背景活动正常。在2型（n = 3）中，意识障碍与异常背景上出现的双侧不对称额叶脑电图放电有关。对5例患者进行了发作期及发作后期99mTc六甲基丙烯胺肟（HMPAO）单光子发射计算机断层扫描（SPECT），显示单侧或双侧额叶HMPAO摄取，有助于定位，尤其是在额叶起源的2型NCSE中。病因包括6例患者有局灶性额叶病变（其中3例为肿瘤）、神经梅毒和非酮症高血糖。8例患者对初始静脉注射苯二氮䓬（BZ）无反应，但静脉注射苯妥英成功控制了6例患者。所有患者的近期预后良好。7例患者无SE长期复发。
额叶起源的NCSE是一种异质性综合征。一些病例最好描述为简单部分性NCSE，另一些为复杂部分性SE，还有一些形式与失神SE重叠。紧急脑电图和神经心理学评估具有诊断价值，SPECT可能有用。许多患者可能对静脉注射BZ无反应。
