Dupont S, Samson Y, Nguyen-Michel V-H, Zavanone C, Navarro V, Baulac M, Adam C
Epilepsy Unit, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France.
Rehabilitation Unit, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France.
Acta Neurol Scand. 2015 Dec;132(6):401-9. doi: 10.1111/ane.12409. Epub 2015 Apr 9.
Analysing the clinical characteristics of seizures constitutes a fundamental aspect of the presurgical evaluation of patients with medial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE-HS), the most frequent form of focal epilepsy accessible to surgery. We sought to retrospectively determine whether objective manifestations could have a reliable lateralizing value in a large population of MTLE-HS patients and if their presence could help to identify those patients who would be seizure free after surgery.
We analysed the frequency and predictive lateralizing value of objective ictal and postictal signs in 391 patients with MTLE-HS (183 left/208 right). Data were derived from chart review and not from blinded videoEEG analysis. Correlation between the presence of reliable lateralizing signs and postoperative outcome was performed in a subgroup of 302 patients who underwent surgery.
Contralateral dystonic posturing was the most frequent and reliable lateralizing sign that correctly lateralized the focus in 96% of patients. Unilateral head/eye deviation was noted in 42% of the patients and predicted unilateral focus in 67%. Ipsilateral postictal nose wiping, contralateral clonus and hypokinesia correctly lateralized the focus in 75%, 81%, respectively, and 100 of patients but were less frequently depicted. Postictal aphasia was a strong lateralizing sign for left MLE-HS. The presence of reliable lateralizing signs was not a predictor of seizure freedom.
Seizure semiology is a simple tool that may permit reliable lateralization of the seizure focus in MTLE-HS. The presence of reliable lateralizing signs is not associated with a better postoperative outcome.
分析癫痫发作的临床特征是内侧颞叶癫痫伴单侧海马硬化（MTLE-HS）患者术前评估的一个基本方面，MTLE-HS是最常见的可手术治疗的局灶性癫痫形式。我们试图回顾性确定客观表现是否在大量MTLE-HS患者中具有可靠的定位价值，以及这些表现的存在是否有助于识别术后无癫痫发作的患者。
我们分析了391例MTLE-HS患者（183例左侧/208例右侧）发作期和发作后期客观体征的频率及预测定位价值。数据来源于病历回顾，而非盲法视频脑电图分析。在302例接受手术的患者亚组中，对可靠定位体征的存在与术后结果进行相关性分析。
对侧张力障碍姿势是最常见且可靠的定位体征，在96%的患者中能正确定位病灶。42%的患者出现单侧头/眼偏斜，其中67%可预测单侧病灶。同侧发作后擦鼻、对侧阵挛和运动减退分别在75%、81%和100%的患者中能正确定位病灶，但出现频率较低。发作后失语是左侧MTLE-HS的一个有力定位体征。可靠定位体征的存在并非无癫痫发作的预测指标。
癫痫发作症状学是一种简单的工具，可在MTLE-HS中实现癫痫病灶的可靠定位。可靠定位体征的存在与较好的术后结果无关。
