Blume W T, Ociepa D, Kander V
London Health Sciences Centre--University Campus, the University of Western Ontario, Canada.
Epilepsia. 2001 Apr;42(4):491-503. doi: 10.1046/j.1528-1157.2001.26700.x.
To study propagation properties of focally originating frontal lobe seizures: principally direction and promptness of ictal spread.
Forty-eight scalp EEG-recorded and 17 subdurally recorded seizures in two separate groups of patients were visually scrutinized.
Initial propagation was directed more commonly to contiguous frontal cortex than to the opposite hemisphere in both studies: 58% and 86% for scalp and subdural recordings, respectively. Eighteen (38%) of scalp EEG seizures propagated within 5-10 s of apparent onset, whereas 16 (33%) did so after 11-20 s; no evidence of propagation could be discerned in the remaining 14 (29%). Of subdurally recorded attacks, only four (24%) propagated in the first 4 s; six (35%) did so after a delay of 5-10 s; six (35%) either failed to propagate or did so after > or =20-s latency. Latency to initial propagation was between 5 and 20 s in 41 (63%) of the 65 seizures in both studies. Ictal activity remained within the frontal lobe of origin for > or =10 s in 39 (81%) of scalp-recorded seizures and 11 (65%) of subdural seizures. It remained so confined for > or =15 s in 26 (54%) and nine (53%), respectively. Twenty-four (50%) of scalp-recorded seizures displayed evidence of opposite hemisphere (bisynchronous or other contralateral) involvement, occurring 5-10 s after onset in eight (17%) seizures and 10-20 s after onset in 16 (33%). Similarly, the subdural study documented spread to the opposite hemisphere in 11 (65%) of seizures with a latency ranging from 1 to 45 s.
Frontal lobe seizures in this study propagated less promptly than reputed, and initial spread occurred more commonly to the frontal lobe of origin than to the opposite hemisphere. Such properties underlie the good lateralizing value of clinical semiology of frontal lobe seizures.
研究起源于额叶局部的癫痫发作的传播特性：主要是发作期扩散的方向和迅速程度。
对两组患者中48例头皮脑电图记录的癫痫发作和17例硬膜下记录的癫痫发作进行了视觉仔细检查。
在两项研究中，初始传播更常见地指向相邻的额叶皮质而非对侧半球：头皮记录和硬膜下记录分别为58%和86%。18例（38%）头皮脑电图癫痫发作在明显发作后5 - 10秒内传播，而16例（33%）在11 - 20秒后传播；其余14例（29%）未发现传播迹象。在硬膜下记录的发作中，只有4例（24%）在最初4秒内传播；6例（35%）在延迟5 - 10秒后传播；6例（35%）要么未传播，要么在潜伏期≥20秒后传播。在两项研究的65例癫痫发作中，41例（63%）初始传播的潜伏期在5至20秒之间。39例（81%）头皮记录的癫痫发作和11例（65%）硬膜下癫痫发作的发作期活动在起源额叶内持续≥10秒。分别有26例（54%）和9例（53%）如此局限持续≥15秒。24例（50%）头皮记录的癫痫发作显示有对侧半球（双同步或其他对侧）受累的证据，8例（17%）发作在发作后5 - 10秒出现，16例（33%）在发作后10 - 20秒出现。同样，硬膜下研究记录了11例（65%）癫痫发作扩散到对侧半球，潜伏期为1至45秒。
本研究中额叶癫痫发作传播不如通常认为的迅速，初始扩散更常见地发生在起源额叶而非对侧半球。这些特性是额叶癫痫发作临床症状学良好定位价值的基础。
