Epilepsy Centre Brno, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic.
Epilepsy Res. 2013 Oct;106(3):386-95. doi: 10.1016/j.eplepsyres.2013.06.015. Epub 2013 Aug 6.
The main purpose of this retrospective analysis was to evaluate the incidence and lateralization value of rhythmic ictal nonclonic hand (RINCH) motions in patients with temporal lobe epilepsy (TLE), who were classified as Engel I at least 2 years after epilepsy surgery. We analyzed the distribution of ictal activity at the time of RINCH appearance in patients in whom RINCH motions were present during invasive EEG monitoring. A group of 120 patients was included in this study. In total, we reviewed 491 seizures: 277 seizures in patients with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (TLE-HS group) and 214 in TLE caused by other lesions (TLE-OTH group). We analyzed 29 patients (79 of the seizures) during invasive EEG monitoring. Fisher's exact test and binomial test were used for the statistical analysis. RINCH motions were observed in 24 out of 120 patients (20%) and in 48 out of 491 seizures (9.8%). There was no significant difference between the occurrence of RINCH motions in patients with TLE-HS and in patients with TLE-OTH, or between gender, right/left-sided TLE, and language dominant/nondominant TLE. RINCH motions were contralateral to the seizure onset in 83.3% of patients and 91.7% of seizures (p=0.0015; p<0.001, respectively). There were no differences in the lateralizing value of RINCH motions in patients with TLE-HS or TLE-OTH. We analyzed RINCH motions in 5 patients/7 seizures during invasive EEG. In all 7 seizures with RINCH motions, we observed the widespread activation of the temporal lobe (mesial and lateral, opercular and polar regions) contralateral to the side of RINCH motions. In all 7 seizures, we observed that at the time of RINCH motion onset, at least 1 explored region of the frontal lobe was affected by the ictal activity. In 3 seizures, we observed time-locked epileptic activation associated with the appearance of RINCH motions, i.e., in the orbitofrontal cortex in 2 seizures and in both the orbitofrontal cortex and anterior cingulate gyrus in 1 seizure. RINCH motions are a relatively frequent ictal sign in patients with TLE. They have a high lateralizing value in these patients, occurring contralateral to the ictal onset. RINCH motions usually occur after the spread of ictal activity beyond the temporal lobe, and their appearance is usually associated with the presence of ictal activity in various regions of the contralateral frontal lobe, mainly the orbitofrontal cortex and anterior cingulate gyrus. This is the first study analysing this phenomenon during invasive EEG recording.
这项回顾性分析的主要目的是评估颞叶癫痫（TLE）患者手术后至少 2 年达到 Engel I 级的患者中节律性阵挛性手部非阵挛（RINCH）运动的发生率和侧化价值。我们分析了在有创脑电图监测期间出现 RINCH 运动的患者中，出现 RINCH 运动时的发作活动分布。这项研究纳入了 120 例患者。总共回顾了 491 次发作：277 次发作与海马硬化（TLE-HS 组）相关，214 次发作与其他病变（TLE-OTH 组）相关。我们分析了 29 例患者（79 次发作）在有创脑电图监测期间的情况。Fisher 确切检验和二项检验用于统计分析。120 例患者中有 24 例（20%）和 491 次发作中有 48 次（9.8%）出现 RINCH 运动。TLE-HS 患者和 TLE-OTH 患者 RINCH 运动的发生率、性别、右侧/左侧 TLE 和语言优势/非优势 TLE 之间均无显著差异。83.3%的患者和 91.7%的发作（p=0.0015;p<0.001）中 RINCH 运动是对侧发生的。TLE-HS 或 TLE-OTH 患者的 RINCH 运动侧化价值无差异。我们在 5 例患者/7 例有创脑电图发作中分析了 RINCH 运动。在所有 7 次出现 RINCH 运动的发作中，我们观察到对侧颞叶（内侧和外侧、外侧和极区）的广泛激活。在所有 7 次发作中，我们观察到在出现 RINCH 运动时，至少有 1 个额叶被探索区域受到发作活动的影响。在 3 次发作中，我们观察到与 RINCH 运动出现相关的时锁性癫痫激活，即在 2 次发作中为眶额皮质，在 1 次发作中为眶额皮质和前扣带回。RINCH 运动是 TLE 患者中相对常见的发作征象。在这些患者中，它们具有很高的侧化价值，与发作起始对侧发生。RINCH 运动通常在发作活动传播超出颞叶后发生，其出现通常与对侧额叶的各种区域（主要是眶额皮质和前扣带回）的发作活动存在相关。这是第一项在有创脑电图记录中分析这种现象的研究。
