C. Munari Center of Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
Epilepsia. 2011 Oct;52(10):1781-91. doi: 10.1111/j.1528-1167.2011.03254.x. Epub 2011 Aug 29.
Sleep-related complex motor seizures are a common feature of nocturnal frontal lobe epilepsy. Nevertheless, recent studies also suggest that sleep-related hypermotor seizures can originate in the insula. The present study describes the electroclinical features of eight drug-resistant epileptic patients with insular-opercular seizures manifesting with nocturnal complex motor seizures.
Patients underwent a comprehensive presurgical evaluation, which included history, interictal electroencephalography (EEG), scalp video-EEG monitoring, high-resolution magnetic resonance imaging (MRI), and intracerebral recording by stereo-EEG.
Almost all patients reported an initial sensation consisting of viscerosensitive or somatosensory symptoms. Ictal clinical signs were represented by tonic-dystonic asymmetric posturing and/or hyperkinetic automatisms, including bimanual/bipedal activity and ballistic movements. Some patients exhibited dysarthric speech, hypersalivation, and apnea. Interictal and ictal EEG provided lateralizing information in the majority of patients. In three patients, MRI showed a focal anatomical abnormality in the insular-opercular region. Stereo-EEG ictal recordings demonstrated that the epileptic discharge involved simultaneously the insular cortex and the opercular region. Complex motor manifestations appeared when the ictal discharge showed an extrainsular spreading to frontomesial regions (cingulum, superior frontal gyrus, and supplementary motor area) and/or to internal and neocortical temporal lobe structures. Six patients received an insular-opercular cortical resection; three of them are seizure free (minimum follow-up 24 months) and in one a marked reduction in seizure frequency was obtained. Two patients have been operated on recently. Histology revealed a focal cortical dysplasia in three patients. One patient excluded from surgery died for sudden unexpected death in epilepsy during sleep.
Our data strengthen the concept that sleep-related complex motor attacks can originate in the insula, and provide useful electroclinical information to differentiate this localization from those with similar clinical characteristics. Furthermore, this study indicates that in these drug-resistant patients, surgical treatment represents a highly effective treatment option.
睡眠相关的复杂运动性发作是夜间额叶癫痫的常见特征。然而，最近的研究也表明，睡眠相关的运动过度性发作可能起源于脑岛。本研究描述了 8 例药物难治性癫痫患者的电临床特征，这些患者表现为夜间复杂运动性发作的岛盖部运动性发作。
患者接受了全面的术前评估，包括病史、发作间期脑电图（EEG）、头皮视频-EEG 监测、高分辨率磁共振成像（MRI）和立体脑电图（EEG）的颅内记录。
几乎所有患者都报告了最初的感觉，包括内脏感觉或躯体感觉症状。发作期的临床症状表现为强直-阵挛性不对称姿势和/或运动过度性自动症，包括双手/双足活动和投掷运动。一些患者出现构音障碍性言语、流涎过多和呼吸暂停。发作间期和发作期 EEG 为大多数患者提供了定位信息。在 3 例患者中，MRI 显示岛盖部区域存在局灶性解剖异常。立体 EEG 发作记录显示，癫痫放电同时累及脑岛皮质和脑岛区域。当癫痫放电显示出岛外扩散到额内侧区域（扣带回、额上回和辅助运动区）和/或到内部和新皮质颞叶结构时，复杂的运动表现出现。6 例患者接受了岛盖部皮质切除术；其中 3 例无癫痫发作（最短随访 24 个月），1 例癫痫发作频率显著减少。2 例患者最近接受了手术。组织学显示 3 例患者存在局灶性皮质发育不良。1 例患者因睡眠中突然意外死亡而被排除在手术之外。
我们的数据加强了睡眠相关的复杂运动发作可能起源于脑岛的概念，并提供了有用的电临床信息，以区分这种定位与具有类似临床特征的定位。此外，这项研究表明，对于这些药物难治性患者，手术治疗是一种非常有效的治疗选择。
