Serrano-Castro Pedro Jesus, Alonso-Morillejo Enrique, Pozo-Muñoz Carmen, Payán-Ortiz Manuel, Quiroga-Subirana Pablo, Fernández-Pérez Javier
Unidad de Neurologia, Complejo Hospitalario Torrecardenas, Almería, Spain.
Clin Neurol Neurosurg. 2013 Aug;115(8):1338-42. doi: 10.1016/j.clineuro.2012.12.033. Epub 2013 Jan 28.
The predominant manifestations of temporal lobe epilepsy (TLE) are partial seizures with impairment of consciousness (type I.B of ILAE classification), although consciousness impairment is not necessary in all seizures of patients with TLE. Nevertheless, there have been very few reports of TLE patients with exclusive seizures with no impairment of consciousness (i.e. isolated auras). The objective of this study was to determine any differential characteristics of this subgroup of TLE patients.
Retrospective case-control study in 163 consecutive TLE patients from our hospital database. The patients were divided between those with and without ictal impairment of consciousness, based on directed semi-structured questionnaire to the patient and relatives and on video-EEG records. Ten independent variables (8 clinical and 2 paraclinical) were compared between the groups.
14 patients (8.5%) formed the "TLE without ictal impairment of consciousness" group. This group was less refractory to medical treatment [Odds Ratio: 0.14 (0.03-0.64); p<0.01] and had frequent ictal motor behaviour [Odds ratio: 5.33 (1.65-17.14); p=0.008] and less frequent presence of automatisms [p<0.001]. Non-significant tendencies were observed for a higher frequency of lesional substrate and fewer generalization episodes.
TLE without ictal impairment of consciousness appears to be more frequent than previously thought. This subgroup of TLE patients shows differential characteristics that may possibly result from a differential propagation of the original epileptic activity towards frontal areas rather than towards neocortical and diencephalic structures, which may be related to the more frequent presence of structural lesions.
颞叶癫痫（TLE）的主要表现为伴有意识障碍的部分性发作（国际抗癫痫联盟分类中的I.B型），尽管并非所有TLE患者的发作都必然伴有意识障碍。然而，关于TLE患者仅出现无意识障碍发作（即孤立性先兆）的报道极少。本研究的目的是确定这一TLE患者亚组的任何差异特征。
对我院数据库中163例连续的TLE患者进行回顾性病例对照研究。根据对患者及其亲属的定向半结构化问卷以及视频脑电图记录，将患者分为有发作期意识障碍和无发作期意识障碍两组。比较两组之间的10个独立变量（8个临床变量和2个辅助临床变量）。
14例患者（8.5%）构成“无发作期意识障碍的TLE”组。该组对药物治疗的耐药性较低[比值比：0.14（0.03 - 0.64）；p < 0.01]，发作期运动行为频繁[比值比：5.33（1.65 - 17.14）；p = 0.008]，自动症出现频率较低[p < 0.001]。在病灶底物频率较高和泛化发作较少方面观察到无显著差异的趋势。
无发作期意识障碍的TLE似乎比以前认为的更为常见。这一TLE患者亚组表现出差异特征，这可能是由于原始癫痫活动向额叶区域而非向新皮质和间脑结构的不同传播所致，这可能与结构病变更频繁出现有关。
