视觉敏感反射性癫痫患者的阵发性眼睑运动。

Paroxysmal eyelid movements in patients with visual-sensitive reflex seizures.

作者信息

Brinciotti Mario, Matricardi Maria

机构信息

Department of Pediatrics and Child Neuropsychiatry, Interdepartmental Research Centre for Social Diseases (CIMS), Childhood Epilepsy Section, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy.

出版信息

Epileptic Disord. 2015 Dec;17(4):372-83. doi: 10.1684/epd.2015.0773.

DOI:10.1684/epd.2015.0773

PMID:26586031

Abstract

AIM

Paroxysmal eyelid movements (PEM) are non-epileptic episodes characterized by eyelid closure, upturning of the eyes, and rapid eyelid flutter. The aim of this study was to report clinical and EEG data of patients with PEM and its relationship with visual sensitivity.

METHODS

We studied 26 patients with epilepsy (12 males and 14 females; mean age: 14.0±6.9 years) who presented PEM. The epilepsy was idiopathic generalized (eight cases), idiopathic focal (six cases), symptomatic focal (five cases), and reflex epilepsy (seven cases). PEM and blinking were analysed by video-EEG recordings at rest and during intermittent photic stimulation, pattern stimulation, and TV watching. Blink rate was evaluated during three different conditions: at rest, during a TV-viewing period, and at the occurrence of PEM. Analysis of variance (ANOVA) was used for statistical comparisons.

RESULTS

Repeated episodes of PEM were recorded in all patients. The frequency of PEM ranged from 8 to 12.5 Hz (average: 9.6±1.5). PEM were accompanied by a significant increase in blinking compared to the rest condition and TV watching (blink rate: 56.5±21.1 vs 25.0±16.2 vs 11.3±11.8, respectively; p<0.0001). Photoparoxysmal EEG responses (measured as sensitivity to photic stimulation) were found in 25 cases, associated with pattern sensitivity in 22; only one patient was sensitive to pattern but not photic stimulation. Visually-induced seizures were recorded in 20 cases, triggered by both stimuli (photic and pattern stimulation) in 11 patients; seizures were triggered by pattern stimulation (but not photic stimulation) in five, photic stimulation (but not pattern stimulation) in three, and TV watching (but not photic or pattern stimulation) in one. Epileptic eyelid myoclonia was noted in 17 patients.

CONCLUSION

The coexistence of PEM, photoparoxysmal EEG responses, increased blinking, and epileptic eyelid myoclonia suggests an underlying dysfunction involving cortical-subcortical neural networks, according to the recent concept of system epilepsies. [Published with video sequences].

摘要

目的

阵发性眼睑运动（PEM）是非癫痫性发作，其特征为眼睑闭合、眼球上翻和快速眼睑颤动。本研究的目的是报告PEM患者的临床和脑电图数据及其与视觉敏感性的关系。

方法

我们研究了26例出现PEM的癫痫患者（12例男性和14例女性；平均年龄：14.0±6.9岁）。癫痫类型为特发性全身性（8例）、特发性局灶性（6例）、症状性局灶性（5例）和反射性癫痫（7例）。通过视频脑电图记录在静息状态以及间歇性光刺激、图形刺激和看电视期间分析PEM和眨眼情况。在三种不同情况下评估眨眼率：静息时、看电视期间以及PEM发作时。采用方差分析（ANOVA）进行统计学比较。

结果

所有患者均记录到多次PEM发作。PEM的频率范围为8至12.5Hz（平均：9.6±1.5）。与静息状态和看电视相比，PEM发作时眨眼显著增加（眨眼率分别为：56.5±21.1、25.0±16.2和11.3±11.8；p<0.0001）。25例患者出现光阵发性脑电图反应（以对光刺激的敏感性衡量），22例与图形敏感性相关；仅1例患者对图形敏感但对光刺激不敏感。20例记录到视觉诱发性癫痫发作，11例由两种刺激（光刺激和图形刺激）触发；5例由图形刺激（而非光刺激）触发，3例由光刺激（而非图形刺激）触发，1例由看电视（而非光刺激或图形刺激）触发。17例患者出现癫痫性眼睑肌阵挛。