Forcadas-Berdusan M I
Servicio de Neurología, Hospital de Cruces, Barakaldo, España.
Rev Neurol. 2002 Sep;35 Suppl 1:S42-6.
In this paper we review the anatomy, clinical features, problems of diagnosis and alternative treatment of the frontal epilepsies.
A knowledge of the functional anatomy of the frontal lobe, the largest in the brain, is essential to understanding the varied features of the epileptic seizures arising in it. Unlike seizures arising in the temporal lobe in which the anatomicoclinical correlation is clearer since the rhinencephalum and especially the amygdala are almost always involved, in frontal seizures it is very difficult to systematize the relationship between the clinical signs and the organization of the discharge since there is wide cortico subcortical propagation, both homolateral and contralateral. There are therefore various types of frontal seizures which we define from a clinical point of view. They are the ones causing the greatest problems of differential diagnosis with epileptic pseudo seizures. A continuous video EEG recording is often necessary to differentiate them. Resonance imaging has meant a major advance in making an aetiological diagnosis of this type of seizure. It can show cortical dysplasia, heterotopia and small tumours or vascular malformations which are not visualized by other means. We give a brief description of the newly discovered genetic frontal epilepsies. Finally we review the different types of treatment indicated for them.
Between 20% and 30% of all partial epilepsies start in the frontal lobe, and they form 30% of all surgical operations. The correct diagnosis of frontal seizures is still a challenge for the neurosurgeon. Advances in neurophysiology, neuro radiology and genetics have been, and still are, very important in better understanding of the disorder.
本文综述额叶癫痫的解剖结构、临床特征、诊断问题及替代治疗方法。
了解大脑中最大的脑叶——额叶的功能解剖结构，对于理解起源于该部位的癫痫发作的多样特征至关重要。与颞叶癫痫发作不同，颞叶癫痫发作时，由于嗅脑尤其是杏仁核几乎总是受累，解剖学与临床的相关性更清晰，而额叶癫痫发作时，由于存在广泛的皮质下皮质传播，包括同侧和对侧，很难将临床体征与放电组织之间的关系系统化。因此，从临床角度定义了各种类型的额叶癫痫发作。它们是与癫痫假性发作鉴别诊断中问题最大的类型。通常需要连续视频脑电图记录来区分它们。磁共振成像在这类癫痫发作的病因诊断方面取得了重大进展。它可以显示皮质发育异常、异位及其他方法无法显示的小肿瘤或血管畸形。我们简要描述了新发现的遗传性额叶癫痫。最后，我们综述了针对它们的不同治疗类型。
所有部分性癫痫发作中，20%至30%起源于额叶，且它们占所有外科手术治疗癫痫的30%。额叶癫痫发作的正确诊断对神经外科医生来说仍然是一项挑战。神经生理学、神经放射学和遗传学的进展过去是、现在仍然是更好地理解这种疾病的非常重要的因素。
