Clarke Dave F, Otsubo Hiroshi, Weiss Shelly K, Chitoku Shiro, Chuang Sylvester H, Logan William J, Smith Mary-Lou, Elliot Irene, Pang Elizabeth W, Rutka James T, Snead O Carter
Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Epilepsia. 2003 Dec;44(12):1562-7. doi: 10.1111/j.0013-9580.2003.34103.x.
The localizing value of ear plugging in the treatment of auditory onset partial seizures, to our knowledge, has not been previously described. We propose that ear plugging is a clinical response to a sensory seizure manifested as an auditory hallucination and a tool for identifying the seizure focus in the auditory cortex on the superior temporal gyrus.
We report on three children who had prior epilepsy surgery for recurrent symptomatic localization-related epilepsy and who, subsequent to their surgery, displayed stereotyped unilateral or bilateral ear plugging at the onset of partial seizures. We studied scalp video electroencephalography (VEEG), magnetoencephalography (MEG), and magnetic resonance imaging (MRI) in all three. Additionally, we used electrocorticography (ECoG) in two patients, intracranial VEEG monitoring in one patient, and functional MRI language mapping in two patients.
All three patients plugged their ears with their hands during auditory auras that localized to the superior temporal gyrus and were followed by partial seizures that spread to a wider field, as shown on scalp and intracranial VEEG. All three patients had MEG interictal discharges in the superior temporal gyrus. One patient who was nonverbal and unable to describe an auditory phenomenon plugged the ear contralateral to where temporal lobe-onset seizures and MEG interictal discharges occurred. CONCLUSIONS; Ear-plugging seizures indicate an auditory aura and may also lateralize seizure onset to the contralateral temporal lobe auditory cortex. Stereotyped behaviors accompanied by epileptic seizures in children who have poor communication skills are important in the seizure semiology of localization-related epilepsy.
据我们所知，耳塞在听觉发作性部分性癫痫治疗中的定位价值此前尚未有过描述。我们提出，耳塞是对表现为幻听的感觉性癫痫发作的一种临床反应，也是确定颞上回听觉皮层癫痫发作灶的一种工具。
我们报告了三名儿童，他们之前因复发性症状性定位相关癫痫接受了癫痫手术，术后在部分性癫痫发作开始时出现刻板的单侧或双侧耳塞动作。我们对这三名儿童均进行了头皮视频脑电图（VEEG）、脑磁图（MEG）和磁共振成像（MRI）检查。此外，我们对两名患者进行了皮质脑电图（ECoG）检查，对一名患者进行了颅内VEEG监测，对两名患者进行了功能MRI语言定位。
如头皮和颅内VEEG所示，所有三名患者在定位于颞上回的听觉先兆期间用手塞耳，随后部分性癫痫发作扩散至更广泛区域。所有三名患者在颞上回均有MEG发作间期放电。一名无法言语且无法描述听觉现象的患者，在颞叶发作性癫痫和MEG发作间期放电发生的对侧塞耳。结论：塞耳发作提示听觉先兆，也可能将癫痫发作起始定位于对侧颞叶听觉皮层。在沟通能力较差的儿童中，癫痫发作时伴随的刻板行为在定位相关癫痫的发作症状学中很重要。
