Bonelli Silvia Beatrice, Lurger Stefanie, Zimprich Fritz, Stogmann Elisabeth, Assem-Hilger Eva, Baumgartner Christoph
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Epilepsia. 2007 Mar;48(3):517-23. doi: 10.1111/j.1528-1167.2006.00943.x.
We systematically analyzed the lateralizing value of clinical seizure semiology in patients with frontal lobe epilepsy (FLE).
We studied the incidence, positive predictive value (PPV), and the lateralizing significance of various clinical symptoms in 228 seizures (s) of 31 patients (p) with medically refractory FLE (17 with left-sided and 14 with right-sided seizure onset). Seizures recorded during prolonged video-EEG monitoring were assessed by two independent reviewers blinded for the patient's clinical data. Analysis was performed both for patients and seizures.
Version [16 p (52%); PPV, 94%; p=0.001; 47 s (21%); PPV, 75%; p=0.001], unilateral clonic movements [16 p (52%); PPV, 81%; p=0.021; 32 s (14%); PPV, 81%; p=0.001], unilateral dystonic posturing [eight p (26%); PPV, 75%; p=0.289; 46 s (20%); PPV, 80%; p=0.001], unilateral tonic posturing [10 p (32%); PPV, 80%; p=0.109; 19 s (7.4%); PPV, 79%; p=0.019], and unilateral grimacing [10 p (32%); PPV, 100%; p=0.002; 19 s (8%); PPV, 100%; p=0.001] were of lateralizing significance, indicating a contralateral seizure onset. Asymmetric ending [five p (16%); PPV, 80%; p=0.375; nine s (4%); PPV, 89%; p=0.039] after secondarily generalized tonic-clonic seizures was significantly associated with an ipsilateral seizure onset. Pure ictal vocalizations occurred significantly more frequently in seizures of right hemispheric onset [13 p (42%); PPV, 62%; p=0.581; 63 s (28%); PPV, 73%; p=0. 001], whereas in individual patients, this symptom showed no lateralizing significance. The remaining clinical symptoms (figure 4 sign, unilateral hand automatisms, early head turning, postictal nose wiping, and unilateral eye blinking) were not of lateralizing significance in our patients. The results of clinical seizure lateralization corresponded with the final lateralization of the seizure-onset zone in 81% of our patients.
Clinical seizure semiology can provide correct information on the lateralization of the seizure-onset zone in >80% of patients with medically refractory frontal lobe epilepsy.
我们系统分析了额叶癫痫（FLE）患者临床发作症状学的定侧价值。
我们研究了31例药物难治性FLE患者（17例左侧发作起始，14例右侧发作起始）的228次发作中各种临床症状的发生率、阳性预测值（PPV）和定侧意义。由两名对患者临床资料不知情的独立评估者对长时间视频脑电图监测期间记录的发作进行评估。对患者和发作均进行了分析。
扭转[16例患者（52%）；PPV，94%；p=0.001；47次发作（21%）；PPV，75%；p=0.001]、单侧阵挛性运动[16例患者（52%）；PPV，81%；p=0.021；32次发作（14%）；PPV，81%；p=0.001]、单侧张力障碍姿势[8例患者（26%）；PPV，75%；p=0.289；46次发作（20%）；PPV，80%；p=0.001]、单侧强直性姿势[10例患者（32%）；PPV，80%；p=0.109；19次发作（7.4%）；PPV，79%；p=0.019]和单侧鬼脸[10例患者（32%）；PPV，10次发作（8%）；PPV，100%；p=0.001]具有定侧意义，提示对侧发作起始。继发性全面强直阵挛发作后的不对称结束[5例患者（16%）；PPV，80%；p=0.375；9次发作（4%）；PPV，89%；p=0.039]与同侧发作起始显著相关。纯发作期发声在右半球发作起始的发作中显著更频繁[13例患者（42%）；PPV，62%；p=0.581；63次发作（28%）；PPV，73%；p=0.001]，而在个体患者中，该症状无定侧意义。其余临床症状（图4征、单侧手部自动症、早期转头、发作后擦鼻和单侧眨眼）在我们的患者中无定侧意义。81%的患者临床发作定侧结果与发作起始区的最终定侧一致。
临床发作症状学可为80%以上药物难治性额叶癫痫患者发作起始区的定侧提供正确信息。
