Leutmezer Fritz, Lurger Stefanie, Baumgartner Christoph
Universitätsklinik für Neurologie, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Epilepsy Res. 2002 Aug;50(3):293-300. doi: 10.1016/s0920-1211(02)00084-0.
The stringent dichotomy between focal and generalized epilepsies has become a contentious issue, since neuropathological studies as well as structural and functional imaging data hypothesized the existence of focal brain abnormalities in patients with well-documented idiopathic generalized epilepsy. The aim of our study was to investigate whether clinical and EEG features generally considered typical for a focal seizure disorder also occur in patients with generalized epilepsies to further support the hypothesis of a more continuous transition between focal and generalized epilepsies in contrast to the present concept of a stringent pathophysiologic dichotomy.
We retrospectively studied 20 consecutive patients with idiopathic generalized epilepsy who underwent video EEG monitoring either because of uncertainty of their epilepsy syndrome or because of a difficult to treat epilepsy. We determined the incidence of (a) focal interictal epileptiform discharges (IEDs), (b) intermittent temporal slow waves, and (c) clinical signs that are widely accepted as typical for a focal seizure onset, i.e. version, tonic/dystonic unilateral posturing, postictal hemiparesis, postictal nose wiping and figure of 4.
Focal IEDs occurred in seven patients (35.0%), intermittent temporal slow waves in six (30%), and clinical signs pointing towards a focal seizure onset were found in seven patients (35%).
Our study of EEG and clinical data supports the more sophisticated previous investigations in which structural and functional imaging as well as histopathological data suggested the presence of focal brain abnormalities in patients with 'generalized' epilepsies. Furthermore we emphasize the cautious use of isolated focal EEG abnormalities and certain clinical signs to prevent a premature diagnosis of focal epilepsy in patients who may indeed suffer from a generalized seizure disorder.
局灶性癫痫与全身性癫痫之间严格的二分法已成为一个有争议的问题，因为神经病理学研究以及结构和功能影像学数据推测，在有充分记录的特发性全身性癫痫患者中存在局灶性脑异常。我们研究的目的是调查通常被认为是局灶性癫痫发作障碍典型特征的临床和脑电图特征是否也出现在全身性癫痫患者中，以进一步支持与目前严格的病理生理二分法概念相反的局灶性癫痫与全身性癫痫之间存在更连续转变的假设。
我们回顾性研究了20例连续的特发性全身性癫痫患者，这些患者因癫痫综合征不确定或癫痫难以治疗而接受了视频脑电图监测。我们确定了以下情况的发生率：（a）局灶性发作间期癫痫样放电（IEDs），（b）间歇性颞叶慢波，以及（c）被广泛认为是局灶性癫痫发作起始典型特征的临床体征，即眼球偏转、强直性/张力障碍性单侧姿势、发作后偏瘫、发作后擦鼻动作和4字征。
7例患者（35.0%）出现局灶性IEDs，6例（30%）出现间歇性颞叶慢波，7例患者（35%）发现指向局灶性癫痫发作起始的临床体征。
我们对脑电图和临床数据的研究支持了之前更为复杂的研究，其中结构和功能影像学以及组织病理学数据表明“全身性”癫痫患者存在局灶性脑异常。此外，我们强调应谨慎使用孤立的局灶性脑电图异常和某些临床体征，以防止对可能确实患有全身性癫痫发作障碍的患者过早诊断为局灶性癫痫。
