Karbowski K
Neurologische Universitätsklinik, Inselspital, Bern.
Schweiz Rundsch Med Prax. 1990 Jun 12;79(24):772-6.
Clinically it is often very difficult to distinguish rudimentary psychomotor seizures from absence seizures and sudden nonepileptic disturbances, especially from transitory cerebral ischaemia. In contrast to absence seizures during which bifrontally accentuated spike-wave activity is registered in the EEG, absence like psychomotor seizures usually present with unilateral temporal or frontotemporal EEG discharges. Syncopal and psychomotor attacks may overlap in the following context: falls resembling syncope during psychomotor seizures, the so-called "temporal fainting spells"; cardiac arrhythmias during psychomotor attacks; psychomotor symptoms such as automatisms and/or "dreamy states" that occur during syncopal attacks with transient dysfunction of the limbic system; alternating psychomotor and syncopal attacks in the same patient Symptoms of intermittent vertebrobasilar insufficiency: non-systematic vertigo, brief blurring of consciousness and blackouts may all be misinterpreted as rudimentary psychomotor seizures. The further differential diagnosis includes psychogenic attacks as well as states of confusion due to a variety of diseases in internal medicine.
临床上,区分原发性精神运动性癫痫发作与失神发作及突发性非癫痫性障碍,尤其是与短暂性脑缺血,往往非常困难。与失神发作(脑电图显示双额叶尖慢波活动增强)不同,类似失神的精神运动性癫痫发作通常表现为单侧颞叶或额颞叶脑电图放电。晕厥和精神运动性发作可能在以下情况重叠:精神运动性癫痫发作时类似晕厥的跌倒,即所谓的“颞叶昏厥发作”;精神运动性发作时的心律失常;晕厥发作伴边缘系统短暂功能障碍时出现的自动症和/或“梦幻状态”等精神运动症状;同一患者交替出现精神运动性发作和晕厥发作。间歇性椎基底动脉供血不足的症状:非系统性眩晕、短暂意识模糊和昏厥都可能被误诊为原发性精神运动性癫痫发作。进一步的鉴别诊断包括心因性发作以及内科各种疾病导致的意识模糊状态。