Krumholz A, Stern B J, Stern E G
Department of Neurology, University of Maryland School of Medicine, Baltimore.
Arch Neurol. 1991 Aug;48(8):842-4. doi: 10.1001/archneur.1991.00530200084023.
Seizures are a recognized manifestation of neurosarcoidosis, but their clinical relevance is not well established. We reviewed the characteristics, clinical correlations, and prognosis of seizures in 79 patients with neurosarcoidosis. Thirteen (15%) of the 79 patients had seizures, and in eight patients (10%) a seizure was the first manifestation of neurosarcoidosis. These seizures were generalized tonic-clonic seizures in 12 patients (92%) and partial seizures in four patients (31%). The patients with neurosarcoidosis with seizures were more likely to have a progressive or relapsing clinical course and intracranial mass lesions (four patients [31%]), encephalopathy or vasculopathy (eight patients [62%]), or hydrocephalus (five patients [38%]). These central nervous system disorders, rather than the seizures per se, were responsible for most of the serious morbidity and the two deaths (15%) among our patients with seizures. Indeed seizure control was good in 11 (85%) of 13 patients treated with combinations of steroids and antiepileptic medications. Seizures are an important sign in neurosarcoidosis because they are associated with more severe and progressive or relapsing forms of central nervous system sarcoidosis and may be an early manifestation of such disorders.
癫痫发作是神经结节病的一种公认表现，但其临床相关性尚未明确确立。我们回顾了79例神经结节病患者癫痫发作的特征、临床关联及预后情况。79例患者中有13例（15%）出现癫痫发作，其中8例（10%）癫痫发作是神经结节病的首发表现。这些癫痫发作中，12例患者（92%）为全面性强直阵挛发作，4例患者（31%）为部分性发作。患有癫痫发作的神经结节病患者更有可能出现病情进展或复发的临床过程以及颅内占位性病变（4例患者[31%]）、脑病或血管病变（8例患者[62%]）或脑积水（5例患者[38%]）。在我们患有癫痫发作的患者中，这些中枢神经系统疾病而非癫痫发作本身，是导致大多数严重发病情况及2例死亡（15%）的原因。实际上，在13例接受类固醇和抗癫痫药物联合治疗的患者中，11例（85%）癫痫发作得到了良好控制。癫痫发作是神经结节病的一个重要体征，因为它们与更严重、病情进展或复发的中枢神经系统结节病形式相关，并且可能是此类疾病的早期表现。
