Diaz-Arrastia R, Agostini M A, Frol A B, Mickey B, Fleckenstein J, Bigio E, Van Ness P C
Department of Neurology, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75235-9036, USA.
Arch Neurol. 2000 Nov;57(11):1611-6. doi: 10.1001/archneur.57.11.1611.
There is controversy regarding the precise mechanism by which epilepsy results after traumatic brain injury (TBI). Previous reports have suggested that mesial temporal lobe epilepsy may result from TBI only in young children, while neocortical epilepsy arises from TBI in later life. These conclusions were based on surgical series and may be biased because of patient selection.
To determine the frequency of mesial temporal lobe as opposed to neocortical epilepsy in patients with intractable epilepsy resulting from TBI after the age of 10 years.
We identified 23 patients with intractable epilepsy who had TBI after the age of 10 years, preceding the onset of epilepsy. Patients were studied by simultaneous videotape and scalp electroencephalographic recording of typical seizures; magnetic resonance imaging; neuropsychologic studies; and, when appropriate, intracarotid amobarbital testing. Two patients underwent anterior temporal lobectomies.
Of the 23 patients, 8 (35%) had mesial temporal lobe epilepsy, based on the finding of hippocampal sclerosis on a magnetic resonance imaging scan, consistent interictal and ictal electroencephalographic recordings, evidence of temporal lobe dysfunction on neuropsychologic testing, and characteristic seizure semiology. Two of these patients underwent anterior temporal lobectomies with clinical benefit, and hippocampal sclerosis was confirmed pathologically. In 2 cases, patients were not treated surgically because of bilateral temporal lobe dysfunction noted on intracarotid amobarbital testing. Eleven patients had neocortical epilepsy; 1 had primary generalized epilepsy; and, in 3, the site of seizure onset was not localized.
Mesial temporal lobe epilepsy can result from TBI in adolescents and adults as well as in children, and can often be bilateral and associated with multifocal injury. This information may be useful in developing prophylactic therapy for posttraumatic epilepsy.
创伤性脑损伤（TBI）后癫痫发作的确切机制存在争议。先前的报告表明，内侧颞叶癫痫可能仅在幼儿期由TBI引起，而新皮质癫痫则在晚年由TBI引起。这些结论基于手术病例系列，可能因患者选择而存在偏差。
确定10岁以后因TBI导致的难治性癫痫患者中内侧颞叶癫痫与新皮质癫痫的发生频率。
我们确定了23例10岁以后发生TBI且在癫痫发作之前就患有难治性癫痫的患者。通过同步录像和头皮脑电图记录典型发作对患者进行研究；进行磁共振成像；神经心理学研究；以及在适当情况下进行颈内动脉阿米妥试验。两名患者接受了前颞叶切除术。
在这23例患者中，8例（35%）患有内侧颞叶癫痫，这是基于磁共振成像扫描发现海马硬化、发作间期和发作期脑电图记录一致、神经心理学测试显示颞叶功能障碍以及特征性发作症状学。其中两名患者接受了前颞叶切除术并获得临床益处，病理证实存在海马硬化。在2例患者中，由于颈内动脉阿米妥试验显示双侧颞叶功能障碍而未进行手术治疗。11例患者患有新皮质癫痫；1例患有原发性全身性癫痫；3例患者的癫痫发作起始部位未定位。
内侧颞叶癫痫可由青少年、成年人以及儿童的TBI引起，且常为双侧性并与多灶性损伤相关。该信息可能有助于制定创伤后癫痫的预防性治疗方案。
