Ohtsu Mayu, Oguni Hirokazu, Awaya Yutaka, Osawa Makiko
Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Japan.
Brain Dev. 2002 Jun;24(4):231-8. doi: 10.1016/s0387-7604(02)00035-9.
This study investigated the clinical and EEG characteristics of initial status epilepticus (SE) during infancy in patients with mesial temporal lobe epilepsy (MTLE). The subjects were six patients who had been brought to our emergency clinic and treated for their initial SE between 1977 and 1988, and later developed MTLE. We reviewed the medical records and laboratory findings at the time of the initial SE, and the clinical evolution up to the development of MTLE. The six patients included four females and two males. The initial SE developed at ages ranging from 7 months to 2 years and 9 months with a mean of 1 year and 2 months. These episodes were characterized by an elevated temperature of more than 38 degrees C (4/6 cases), clusters of prolonged seizures during one episode of SE (4/6 cases), long-lasting SE (120-380 min, mean 227 min, 6/6 cases), postictal prolonged loss of consciousness (median 5 h, 6/6 cases), and the presence of Todd's paralysis (3/6 cases). The lateralization of the ictal or postictal EEGs of the SE in five of the six cases was identical to that of the hippocampal atrophy later confirmed by MRI. Follow-up EEG examinations at a 6 month interval demonstrated temporal spike discharges appearing only after the onset of complex partial seizures. Two patients, who had no fever at the initial SE, were characterized by a very early appearance of epileptic EEG abnormality and a short interval between the initial SE and the development of complex partial seizures, suggesting that the SE was the first epileptic manifestation. The result of this study showed that SE progressing to MTLE tends to have complicated clinical manifestations characterized by clusters of unilateral or generalized SE followed by prolonged postictal unconsciousness, generalized clinical manifestations despite lateralized ictal EEG discharges, and the Todd's paresis in addition to the prolonged seizure duration.
本研究调查了内侧颞叶癫痫（MTLE）患者婴儿期首次癫痫持续状态（SE）的临床和脑电图特征。研究对象为1977年至1988年间被送至我院急诊室并接受首次SE治疗、随后发展为MTLE的6例患者。我们回顾了首次SE发作时的病历和实验室检查结果，以及直至MTLE发生时的临床演变情况。这6例患者中包括4名女性和2名男性。首次SE发作年龄在7个月至2岁9个月之间，平均为1岁2个月。这些发作的特点包括体温超过38摄氏度（4/6例）、一次SE发作期间出现成串的长时间发作（4/6例）、长时间SE（120 - 380分钟，平均227分钟，6/6例）、发作后长时间意识丧失（中位数5小时，6/6例）以及存在托德麻痹（3/6例）。6例患者中有5例SE发作期或发作后期脑电图的定位与后来MRI证实的海马萎缩定位相同。每隔6个月进行的随访脑电图检查显示，颞叶尖波放电仅在复杂部分性发作开始后出现。2例首次SE发作时无发热的患者，其特点是癫痫脑电图异常出现非常早，且首次SE发作与复杂部分性发作发生之间的间隔时间短，提示该SE是首次癫痫表现。本研究结果表明，进展为MTLE的SE往往具有复杂的临床表现，其特征为单侧或全身性SE成串发作，随后是长时间的发作后意识丧失、尽管发作期脑电图放电呈单侧性但仍有全身性临床表现，以及除了发作持续时间延长外还存在托德轻瘫。
