Kotagal P, Arunkumar G, hammel J, Mascha Ed
Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Seizure. 2003 Jul;12(5):268-81. doi: 10.1016/s1059-1311(02)00276-5.
To identify the ictal semiology of complex partial seizures originating from the frontal lobe (FLCPS) and mesial temporal lobe (MTLE) in patients who became seizure free after surgery.
We analysed 149 seizures from 42 patients, 28 with MTLE (75 seizures) and 14 with FLCPS (74 seizures) seizure free for at least 1 year after surgery. Fifty-eight symptoms and signs were looked for in every seizure and their time of onset and ending noted. Statistical analysis was then used to define the frequency, time of onset and cluster analysis of these symptoms/signs.
Epigastric aura was more frequent in MTLE while an aura of a general body sensation or indescribable feeling occurred only in FLCPS. Alimentary automatisms were more common and occurred earlier in MTLE (P<0.001). Perseverative automatisms, retching and vomiting occurred exclusively in MTLE while bicycling movements occurred only in FLCPS. Abdominal, psychic or olfactory aura followed by behavioural arrest, alimentary automatisms, repetitive distal upper extremity movements, complete loss of consciousness, looking around and whole body movements were typical of MTLE. Repetitive coarse upper extremity movements, complete loss of consciousness, complex motor and hypermotor activity were typical of FLCPS.
The earliest symptoms and signs as well as their order of appearance allow one to distinguish between complex partial seizures arising from the frontal lobe and mesial temporal lobe.
确定术后无癫痫发作的患者中源自额叶（FLCPS）和内侧颞叶（MTLE）的复杂部分性发作的发作期症状学。
我们分析了42例患者的149次发作，其中28例为MTLE（75次发作），14例为FLCPS（74次发作），术后至少1年无癫痫发作。在每次发作中寻找58种症状和体征，并记录其发作和结束时间。然后进行统计分析以确定这些症状/体征的频率、发作时间和聚类分析。
上腹部先兆在MTLE中更常见，而全身感觉或难以形容的感觉先兆仅在FLCPS中出现。进食自动症在MTLE中更常见且发作更早（P<0.001）。持续性自动症、干呕和呕吐仅发生在MTLE中，而骑自行车样动作仅发生在FLCPS中。腹部、精神或嗅觉先兆后伴有行为停止、进食自动症、重复性远端上肢运动、意识完全丧失、环顾四周和全身运动是MTLE的典型表现。重复性粗大上肢运动、意识完全丧失、复杂运动和多动是FLCPS的典型表现。
最早的症状和体征及其出现顺序有助于区分源自额叶和内侧颞叶的复杂部分性发作。
