Morano Alessandra, Carnì Marco, Casciato Sara, Vaudano Anna Elisabetta, Fattouch Jinane, Fanella Martina, Albini Mariarita, Basili Luca Manfredi, Lucignani Giulia, Scapeccia Marco, Tomassi Regina, Di Castro Elisabetta, Colonnese Claudio, Giallonardo Anna Teresa, Di Bonaventura Carlo
Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy.
Department of Molecular medicine, University "Sapienza", Rome, Italy.
Epilepsy Behav. 2017 Mar;68:51-56. doi: 10.1016/j.yebeh.2016.12.031. Epub 2017 Jan 19.
Vertigo and dizziness are extremely common complaints, related to either peripheral or central nervous system disorders. Among the latter, epilepsy has to be taken into consideration: indeed, vertigo may be part of the initial aura of a focal epileptic seizure in association with other signs/symptoms, or represent the only ictal manifestation, a rare phenomenon known as "vertiginous" or "vestibular" seizure. These ictal symptoms are usually related to a discharge arising from/involving temporal or parietal areas, which are supposed to be a crucial component of the so-called "vestibular cortex". In this paper, we describe three patients suffering from drug-resistant focal epilepsy, symptomatic of malformations of cortical development or perinatal hypoxic/ischemic lesions located in the posterior regions, who presented clusters of vertiginous seizures. The high recurrence rate of such events, recorded during video-EEG monitoring sessions, offered the opportunity to perform an ictal EEG/fMRI study to identify seizure-related hemodynamic changes. The ictal EEG/fMRI revealed the main activation clusters in the temporo-parieto-occipital regions, which are widely recognized to be involved in the processing of vestibular information. Interestingly, ictal deactivation was also detected in the ipsilateral cerebellar hemisphere, suggesting the ictal involvement of cortical-subcortical structures known to be part of the vestibular integration network.
眩晕和头晕是极为常见的症状，与周围或中枢神经系统疾病相关。在后者中，必须考虑癫痫：事实上，眩晕可能是局灶性癫痫发作初始先兆的一部分，并伴有其他体征/症状，或者是唯一的发作期表现，这是一种罕见的现象，称为“眩晕性”或“前庭性”发作。这些发作期症状通常与起源于/涉及颞叶或顶叶区域的放电有关，这些区域被认为是所谓“前庭皮层”的关键组成部分。在本文中，我们描述了三名患有药物难治性局灶性癫痫的患者，其症状表现为位于后部区域的皮质发育畸形或围产期缺氧/缺血性病变，他们出现了眩晕性发作簇。在视频脑电图监测期间记录到的此类事件的高复发率，为进行发作期脑电图/功能磁共振成像研究以识别与发作相关的血流动力学变化提供了机会。发作期脑电图/功能磁共振成像显示颞顶枕区域有主要激活簇，这些区域被广泛认为参与前庭信息的处理。有趣的是，在同侧小脑半球也检测到发作期失活，这表明已知为前庭整合网络一部分的皮质 - 皮质下结构在发作期受到影响。
