Azar Nabil J, Lagrange Andre H, Abou-Khalil Bassel W
Neurology Department, Vanderbilt University Medical Center, A-0118 MCN 2551, Nashville, TN 37232-2551, USA.
Clin Neurophysiol. 2009 Apr;120(4):665-72. doi: 10.1016/j.clinph.2009.01.010. Epub 2009 Mar 4.
Some seizures are characterized by a transitional sharp wave (TShW) at ictal onset. We evaluated the clinical significance and localizing value of TShW in partial-onset seizures.
We identified and analyzed all scalp ictal recordings with a TShW at ictal onset in the Vanderbilt Epilepsy Monitoring Unit over a period of 12 months.
A total of 52 ictal discharges in 13 patients started with a TShW. The center of TShW field was concordant with the final localization/lateralization, while that of the subsequent ictal discharge was concordant in only 6 patients. The subsequent rhythmic ictal discharge was non-localizing in 4 patients and misleading in the remaining 3 patients. The final localization was neocortical temporal or frontal in 11 patients, occipito-parietal in one, and undetermined in 1 patient. None of 61 ictal discharges in 15 patients with mesial temporal lobe epilepsy studied in the same time period started with a TShW.
In this patient series, the TShW was a marker of neocortical seizure onset. The TShW field provided more accurate localization or lateralization of the ictal focus than the following rhythmic ictal discharge.
TShW at seizure onset should suggest a neocortical rather than hippocampal seizure onset.
部分癫痫发作的特征是发作起始时出现过渡性锐波（TShW）。我们评估了TShW在部分性发作中的临床意义和定位价值。
我们识别并分析了范德比尔特癫痫监测单元在12个月期间所有发作起始时有TShW的头皮发作期记录。
13例患者共有52次发作期放电起始于TShW。TShW场的中心与最终定位/定侧一致，而随后发作期放电的中心仅在6例患者中一致。随后的节律性发作期放电在4例患者中无定位价值，在其余3例患者中具有误导性。最终定位在11例患者中为新皮质颞叶或额叶，1例为枕顶叶，1例未确定。同期研究的15例内侧颞叶癫痫患者的61次发作期放电均无起始于TShW的情况。
在该患者系列中，TShW是新皮质癫痫发作起始的标志。TShW场比随后的节律性发作期放电能更准确地定位发作灶或进行定侧。
发作起始时的TShW提示新皮质而非海马体癫痫发作起始。
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