Villanueva Vicente, Serratosa José Maria
Neurology Department, Fundacion Jimenez Diaz, Madrid, Spain.
Epileptic Disord. 2005 Jun;7(2):83-90.
The objective of this study was to define the clinical semiology of seizures in temporal lobe epilepsy according to the age at onset. We analyzed 180 seizures from 50 patients with medial or neocortical temporal lobe epilepsy who underwent epilepsy surgery between 1997-2002, and achieved an Engel class I or II outcome. We classified the patients into two groups according to the age at the first seizure: at or before 17 years of age and 18 years of age or older. All patients underwent intensive video-EEG monitoring. We reviewed at least three seizures from each patient and analyzed the following clinical data: presence of aura, duration of aura, ictal and post-ictal period, clinical semiology of aura, ictal and post-ictal period. We also analyzed the following data from the clinical history prior to surgery: presence of isolated auras, frequency of secondary generalized seizures, and frequency of complex partial seizures. Non-parametric, chi-square tests and odds ratios were used for the statistical analysis. There were 41 patients in the "early onset" group and 9 patients in the "later onset" group. A relationship was found between early onset and mesial temporal lobe epilepsy and between later onset and neocortical temporal lobe epilepsy (p = 0.04). The later onset group presented a higher incidence of blinking during seizures (p = 0.03), a longer duration of the post-ictal period (p = 0.07) and a lower number of presurgical complex partial seizures (p = 0.03). The other parameters analyzed showed no significant differences between the two groups. We conclude that clinical and semiological differences exist between patients with temporal lobe epilepsy according to the age at onset. [Published with video sequences].
本研究的目的是根据发病年龄确定颞叶癫痫发作的临床症状学。我们分析了1997年至2002年间接受癫痫手术且术后达到恩格尔一级或二级结果的50例内侧或新皮质颞叶癫痫患者的180次发作。我们根据首次发作的年龄将患者分为两组：17岁及以前和18岁及以上。所有患者均接受了强化视频脑电图监测。我们回顾了每位患者至少三次发作，并分析了以下临床数据：先兆的存在、先兆持续时间、发作期和发作后期、先兆的临床症状学、发作期和发作后期。我们还分析了手术前临床病史中的以下数据：孤立先兆的存在、继发性全面性发作的频率和复杂部分性发作的频率。采用非参数检验、卡方检验和比值比进行统计分析。“早发”组有41例患者，“晚发”组有9例患者。发现早发与内侧颞叶癫痫有关，晚发与新皮质颞叶癫痫有关（p = 0.04）。晚发组在发作期间眨眼的发生率较高（p = 0.03），发作后期持续时间较长（p = 0.07），术前复杂部分性发作的次数较少（p = 0.03）。分析的其他参数在两组之间没有显著差异。我们得出结论，根据发病年龄，颞叶癫痫患者之间存在临床和症状学差异。[随视频序列发表]
