Epilepsy Center, Department of Neurology, University of Munich, Marchioninistrasse 15, Munich, Germany.
Epilepsy Res. 2012 May;99(3):274-80. doi: 10.1016/j.eplepsyres.2011.12.007. Epub 2012 Jan 23.
In focal epilepsy, ictal version and ictal dystonia are thought to reflect seizure spread into the frontal eye field and the basal ganglia, respectively. Here we investigated whether the occurrence of dystonia during seizure evolution reflects mechanisms preventing secondary generalization. To this aim, the evolution of seizures in patients with focal epilepsies was compared as to whether concomitant (1) dystonia, (2) dystonia and version, or (3) version occurred.
Seizure evolutions of 79 patients characterized by either dystonia (n=29; 232 seizures), dystonia and head version in the same seizure evolution (n=9; 83 seizures) or head version (n=41; 330 seizures), were included in the study.
The rate of secondary generalization was significant lower in seizures with ictal dystonia (8%, 6 of 72 seizures) compared to seizures with ictal dystonia and version (62%, 13 of 21 seizures, p<0.0001) or compared to seizures with version (95%, 82 of 86 seizures, p<0.0001).
This study shows that seizures with unilateral ictal dystonia are less likely to generalize as compared to seizures associated with version. This effect is likely to reflect the involvement of inhibitory mechanisms related to the basal ganglia, which exert an inhibiting effect on secondary seizure generalization.
在局灶性癫痫中，发作期的偏侧抽搐和发作期的扭转痉挛被认为分别反映了癫痫发作向额眼区和基底节的扩散。在这里，我们研究了在癫痫发作过程中出现扭转痉挛是否反映了阻止继发性泛化的机制。为此，我们比较了局灶性癫痫患者的癫痫发作的演变过程，以确定是否同时发生了（1）扭转痉挛，（2）扭转痉挛和头位偏斜，或（3）头位偏斜。
纳入研究的有 79 名患者的癫痫发作演变过程，这些患者的特征是要么出现扭转痉挛（n=29；232 次发作），要么在同一癫痫发作演变过程中出现扭转痉挛和头部偏斜（n=9；83 次发作），要么出现头部偏斜（n=41；330 次发作）。
与出现扭转痉挛和头位偏斜的癫痫发作（62%，13 次/21 次）或与出现头位偏斜的癫痫发作（95%，82 次/86 次）相比，出现单侧发作期扭转痉挛的癫痫发作继发泛化的发生率显著降低（8%，6 次/72 次，p<0.0001）。
这项研究表明，与伴有头位偏斜的癫痫发作相比，单侧发作期扭转痉挛的癫痫发作不太可能泛化。这种效应可能反映了与基底节有关的抑制机制的参与，这些机制对继发性癫痫发作的泛化具有抑制作用。
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