Blumenfeld H, Rivera M, McNally K A, Davis K, Spencer D D, Spencer S S
Department of Neurology and Neurobiology, Yale University School of Medicine, New Haven, CT, USA.
Neurology. 2004 Sep 28;63(6):1015-21. doi: 10.1212/01.wnl.0000141086.91077.cd.
Temporal lobe epilepsy (TLE) may affect brain regions outside the temporal lobe, causing impaired neocortical function during seizures.
The authors selected 11 consecutive patients with mesial TLE and hippocampal sclerosis who underwent intracranial EEG monitoring and had no seizures during a follow-up period of at least 1 year after temporal lobe resection. Secondarily generalized seizures were excluded, and up to three seizures were analyzed per patient (31 seizures total). Electrode contacts were assigned to one of nine cortical regions based on MRI surface reconstructions. EEG during seizures was analyzed for specific patterns including low-voltage fast (LVF), rhythmic polyspike, spike-wave, irregular slowing, and postictal suppression.
Mesial and lateral temporal contacts on the side of seizure onset showed significant increases in ictal patterns such as LVF and polyspike activity, followed by postictal suppression. Bilateral frontal and ipsilateral parietal cortex exhibited large amplitude irregular slow waves during seizures. This frontoparietal slowing persisted into the postictal period. Perirolandic and occipital cortex were relatively spared. These EEG patterns were accompanied by bland staring, minor automatisms, and unresponsiveness or amnesia in the majority of patients studied.
Prominent irregular slowing occurs in bilateral frontal and ipsilateral parietal association cortex during and after temporal lobe seizures. EEG slowing in the frontoparietal association cortex may signify physiologic impairment that contributes to widespread altered cerebral function during partial seizures.
颞叶癫痫（TLE）可能影响颞叶以外的脑区，导致发作期间新皮质功能受损。
作者选取了11例连续的内侧颞叶癫痫伴海马硬化患者，这些患者接受了颅内脑电图监测，并且在颞叶切除术后至少1年的随访期内无发作。排除继发性全身性发作，每位患者最多分析3次发作（共31次发作）。根据MRI表面重建将电极触点分配到9个皮质区域之一。分析发作期间脑电图的特定模式，包括低电压快速（LVF）、节律性多棘波、棘慢波、不规则慢波和发作后抑制。
发作起始侧的内侧和外侧颞叶触点在发作期模式如LVF和多棘波活动方面显著增加，随后是发作后抑制。双侧额叶和同侧顶叶皮质在发作期间表现出大幅度不规则慢波。这种额顶叶慢波持续到发作后期。中央沟周围和枕叶皮质相对未受影响。这些脑电图模式在大多数研究患者中伴有茫然凝视、轻微自动症以及无反应或失忆。
颞叶癫痫发作期间及发作后，双侧额叶和同侧顶叶联合皮质出现明显的不规则慢波。额顶叶联合皮质的脑电图减慢可能表明生理功能受损，这在部分性发作期间导致广泛的脑功能改变。
