Rathke Kevin M, Schäuble Barbara, Fessler A James, So Elson L
Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Arch Neurol. 2011 Jun;68(6):775-8. doi: 10.1001/archneurol.2011.97.
To determine whether seizure semiology is reliable in localizing and distinguishing seizures at 2 independent brain foci in the same patient.
Two masked reviewers localized seizures from 2 foci by their clinical semiology and intracranial electroencephalograms (EEGs).
Epilepsy monitoring unit of referral comprehensive epilepsy program.
Seventeen consecutive patients (51 seizures) with sufficient video and intracranial EEG data were identified by reviewing medical records of 366 patients older than 10 years.
The primary outcome measures were interobserver agreement between the 2 masked reviewers; the proportion of seizures localized by semiology; the proportion of localized seizures concordant with intracranial EEG localization; and comparison between concordant and nonconcordant seizures in latency of intracranial EEG seizure spread.
Interobserver agreement was 41% (κ score, 0.16). Only 30 of 51 seizures (59%) were localized by seizure semiology. The focus localized by semiology was concordant with the location of intracranial EEG seizure onset in 16 of 30 seizures (53%). No significant difference was observed between concordant and nonconcordant seizures in relation to the speed with which the EEG discharge spread from the location of seizure onset to another lobar region (P = .09, Wilcoxon rank sum test).
Clinical seizure semiology is not as useful as intracranial EEG in localizing seizure onset in patients with dual seizure foci.
确定发作症状学在定位和区分同一患者两个独立脑区的发作方面是否可靠。
两名盲法评估者通过临床症状学和颅内脑电图（EEG）对两个脑区的发作进行定位。
转诊综合癫痫项目的癫痫监测单元。
通过回顾366例10岁以上患者的病历，确定了17例连续患者（51次发作），他们有足够的视频和颅内EEG数据。
主要观察指标为两名盲法评估者之间的观察者间一致性；通过症状学定位的发作比例；通过症状学定位的发作与颅内EEG定位一致的比例；以及在颅内EEG发作传播潜伏期方面，一致发作与不一致发作之间的比较。
观察者间一致性为41%（κ值，0.16）。51次发作中只有30次（59%）通过发作症状学定位。在30次发作中有16次（53%）通过症状学定位的脑区与颅内EEG发作起始位置一致。在EEG放电从发作起始位置传播到另一个脑叶区域的速度方面，一致发作与不一致发作之间未观察到显著差异（P = 0.09，Wilcoxon秩和检验）。
在有双重发作灶的患者中，临床发作症状学在定位发作起始方面不如颅内EEG有用。
