2001年诊断方案及2006年国际抗癫痫联盟（ILAE）癫痫发作与癫痫报告的应用：来自成人癫痫临床实践的反馈

Kinoshita Masako, Takahashi Ryosuke, Ikeda Akio

Department of Neurology, Utano National Hospital, Kyoto, Japan.

Epileptic Disord. 2008 Sep;10(3):206-12. doi: 10.1684/epd.2008.0203.

PURPOSE

To clarify the clinical validity and feasibility of the diagnostic scheme for seizures and epilepsy proposed by the International League Against Epilepsy (ILAE) in 2001 (the 2001 Scheme) and the report of the ILAE classification core group in 2006 (the 2006 Report).

METHODS

One hundred consecutive patients with epilepsy who visited the Neurology Clinic (Group 1) and 100 patients with intractable epilepsy who had undergone prolonged scalp video-EEG monitoring (Group 2) in Kyoto University Hospital were enrolled. The 2001 Scheme (Axis 1 to 4) and the 2006 Report (seizure types and epileptic syndromes) were applied to Group 1. Axis 1 was applied to Group 2 to evaluate the diversity of seizure semiology.

RESULTS

Group 1 demonstrated 145 seizures of different types (generalized tonic-clonic seizures: 23%, complex partial seizures (CPS): 29%, simple partial seizures: 21% and secondarily generalized tonic-clonic seizures: 21% according to the 1981 classification. In Axis 1 (ictal phenomenology) of the 2001 scheme, 184 and 333 items were listed in Groups 1 and 2, respectively, and seizure semiology was described independent of EEG findings. However, there was duplications or discordance among the items. In Axis 2 (seizure types) of Group 1, 62% and 26% of CPS were further labeled as focal motor or sensory seizures, respectively; the remainder (24%) did not meet inclusion criteria for any category. In Axis 3 (epilepsy syndromes), 94% of patients were sorted, and familial temporal lobe epilepsy was added. Axis 4 described detailed etiology. Application of seizure types of the 2006 Report required consideration of ictal phenomenology to determine spread patterns. Epileptic syndromes of the 2006 Report were assignable to 70% of patients.

CONCLUSIONS

It is important to achieve intra- and inter-axial accordance for the establishment of a more practical diagnostic scheme, which may provide a more useful tool for the diagnosis of less obvious aspects of epilepsy.

目的

阐明国际抗癫痫联盟（ILAE）2001年提出的癫痫发作及癫痫诊断方案（2001方案）以及ILAE分类核心小组2006年报告（2006报告）的临床有效性和可行性。

方法

纳入京都大学医院神经内科门诊连续就诊的100例癫痫患者（第1组）以及100例接受长时间头皮视频脑电图监测的难治性癫痫患者（第2组）。将2001方案（轴1至轴4）和2006报告（发作类型和癫痫综合征）应用于第1组。将轴1应用于第2组以评估发作症状学的多样性。

结果

第1组表现出145次不同类型的发作（根据1981年分类：全身强直阵挛发作：23%，复杂部分性发作（CPS）：29%，简单部分性发作：21%，继发全身强直阵挛发作：21%）。在2001方案的轴1（发作期现象学）中，第1组和第2组分别列出了184项和333项，且发作症状学的描述独立于脑电图结果。然而，各项目之间存在重复或不一致。在第1组的轴2（发作类型）中，62%的CPS进一步被标记为局灶性运动性或感觉性发作，分别占；其余（24%）不符合任何类别的纳入标准。在轴3（癫痫综合征）中，94%的患者被分类，并增加了家族性颞叶癫痫。应用2006报告的发作类型需要考虑发作期现象学以确定扩散模式。2006报告的癫痫综合征可应用于70%的患者。