Seneviratne Udaya, Cook Mark, D'Souza Wendyl
Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia; Department of Neuroscience, Monash Medical Centre, Melbourne, Victoria, Australia.
Epilepsia. 2014 Aug;55(8):1157-69. doi: 10.1111/epi.12688. Epub 2014 Jun 17.
Conventionally, epilepsy is dichotomized into distinct "focal" and "generalized" categories. However, many studies have reported so-called focal features among patients with idiopathic generalized epilepsy (IGE) in the domains of semiology, electroencephalography, neuropsychology, neuropathology, and neuroimaging. We sought to review such features and clinical implications. A Web of Science database search was conducted to identify relevant publications. Our search yielded 145 papers describing focal features involving different domains in IGE, with 117 papers analyzed after excluding abstracts and case reports. Focal semiologic features are commonly seen in IGE. There are conflicting data from studies in the domains of electroencephalography, neuroimaging, and neuropathology. Studies on neuropsychology are suggestive of frontal lobe functional deficits in juvenile myoclonic epilepsy. Most advanced neuroimaging studies demonstrate the involvement of both the thalamus and the cortex during generalized spike-wave discharges (GSWDs). A few electroencephalographic and neuroimaging studies indicate that the cortex precedes the thalamus at the onset of GSWD. Focal features may contribute to misdiagnosis of IGE as focal epilepsy. However there are methodologic limitations in the studies that affect the results.
传统上，癫痫被分为截然不同的“局灶性”和“全身性”类别。然而，许多研究报告称，在特发性全身性癫痫（IGE）患者中，在症状学、脑电图、神经心理学、神经病理学和神经影像学等领域存在所谓的局灶性特征。我们试图回顾这些特征及其临床意义。通过对科学网数据库进行检索以识别相关出版物。我们的检索得到了145篇描述IGE中涉及不同领域的局灶性特征的论文，排除摘要和病例报告后，对117篇论文进行了分析。局灶性症状学特征在IGE中很常见。脑电图、神经影像学和神经病理学领域的研究数据存在冲突。神经心理学研究提示青少年肌阵挛癫痫存在额叶功能缺陷。大多数先进的神经影像学研究表明，在全身性棘波放电（GSWDs）期间，丘脑和皮层均受累。一些脑电图和神经影像学研究表明，在GSWD开始时，皮层先于丘脑受累。局灶性特征可能导致IGE被误诊为局灶性癫痫。然而，这些研究存在方法学上的局限性，影响了研究结果。
